Evaluation of Sudden Cardiac Death, Using Cardiovascular Magnetic Resonance

Abstract

Coronary artery disease is the most frequent cause of SCD in individuals over the age of 30, while hypertrophic cardiomyopathy in those below 30 years of age. Cardiac magnetic resonance (CMR), a noninvasive, non-radiating technique, can reliably perform evaluation of 1) cardiac function through assessment of ventricular volumes and ejection fraction and 2) tissue characterization through oedema, fat and fibrotic substrate assessment. The presence of scar has been linked to ventricular arrhythmias, which is believed to be the major cause of SCD in both ischemic and nonischemic cardiomyopathy.The extent of late gadolinium enhancement (LGE) in hypertrophic cardiomyopathy is correlated with risk factors of SCD. In idiopathic dilated cardiomyopathy, the presence of midwall fibrosis, assessed by CMR, also predicts SCD. In coronary artery disease, infarct size is the strongest predictor of SCD. LGE around infundibular patch and RV anterior wall, among other functional parameters, also play an important role in SCD prediction in repaired Tetralogy of Fallot (TOF). Finally, in treated transposition of great arteries (TGA), the extent of LGE in systemic RV also correlates with SCD development.