Cardiac Magnetic Resonance Imaging for Nonischemic Cardiac Disease in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management: A Multicenter Retrospective Analysis.

Sang-Min Kim,Tae-Gun Shin,Chun-Song Youn,June-Sung Kim,Won-Young Kim,Youn-Jung Kim,Gun-Tak Lee

doi:10.3390/jcm10040794

Abstract

(1) Background: Cardiac magnetic resonance (CMR) imaging is an emerging tool for investigating nonischemic cardiomyopathies and cardiac systemic disease. However, data on the cardiac arrest population are limited. This study aimed to evaluate the usefulness of CMR imaging in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). (2) Methods: We conducted the retrospective observational study using a multicenter registry of adult non-traumatic comatose OHCA survivors who underwent TTM between January 2010 and December 2019. Of the 949 patients, 389 with OHCA of non-cardiac cause, 145 with significant lesions in the coronary artery, 151 who died during TTM, 81 without further evaluation due to anticipated poor neurological outcome, and 51 whose etiology is underlying disease were excluded. In 36 of the 132 remaining patients, the etiologies included variant angina, long QT syndrome, and complete atrioventricular block in ancillary studies. Fifty-six patients were diagnosed idiopathic ventricular fibrillation without CMR. (3) Results: CMR imaging was performed in the remaining 40 patients with cardiac arrest of unknown cause. The median time from cardiac arrest to CMR imaging was 10.1 days. The CMR finding was normal in 23 patients, non-diagnostic in 12, and abnormal in 5, which suggested non-ischemic cardiomyopathy but did not support the final diagnosis. (4) Conclusions: CMR imaging may not be useful for identifying unknown causes of cardiac arrest in OHCA survivors treated with targeted temperature management without definitive diagnosis even after coronary angiography, echocardiography, and electrophysiology studies. However, further large-scale studies will be needed to confirm these findings.

Highlights

Targeted temperature management (TTM) is generally recommended for patients who are comatose after post-cardiac arrest [2]
Ischemic heart disease is well known to account for most cases with cardiac origin of arrest, the proportion of cases of other causes, which can be divided into structural or electrical abnormalities, is not negligible [3]
(≥18 years) patients with non-traumatic of-hospital cardiac arrest (OHCA) treated with TTM between January 2010 and December 2019 were extracted from prospectively collected OHCA registry data [15,16,17,18]

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death in industrialized countries [1]. Ischemic heart disease is well known to account for most cases with cardiac origin of arrest, the proportion of cases of other causes, which can be divided into structural (non-ischemic cardiomyopathy, sarcoidosis, amyloidosis, and myocarditis) or electrical abnormalities (long QT syndrome, Brugada syndrome, and polymorphic ventricular tachycardia), is not negligible [3]. The cause of OHCA can remain uncertain even after echocardiography and coronary angiography. A previous study reported that approximately 40% of cases remain without an overt diagnosis despite vigorous efforts to elucidate the causes of cardiac arrest [4]. It is still difficult to elucidate the etiology of cardiac arrest without significant coronary artery lesion for physicians

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