Novel Mri–based Screening Protocol to Identify Adolescents at High Risk of Sudden Cardiac Death

Novel Imaging of Coronary Artery Anomalies to Assess Their Prevalence, the Causes of Clinical Symptoms, and the Risk of Sudden Cardiac Death

“…13,19 In a later analysis of our 3165 initial cases, we found that >99% (9432 of 9495) of the expected coronary arteries (the 3 proximal trunks of the left anterior descending, circumflex, and right coronary artery) were clearly identified 19 ; in 0.007% of cases (most likely involving the circumflex artery), we could not reach a definitive diagnosis (Figure 2). At this initial stage of reporting, it seems that 0.7% of this young general population has ACAOS (including R-ACAOS in 0.5% of cases) and that the total prevalence of high-risk cardiovascular conditions is 1.6%, or >5× what it was previously assumed to be (0.3%).…”

“…17 To fully appreciate the importance of ACAOS, the prevalence of these anomalies in the population under study 18 needs to be identified; this need was not clearly recognized until recently. 13,19 The initial popularization of coronary angiography from the 1970s into the 1990s 5 led to extensive but inconsistent reports about the prevalence of CAAs. These reports were limited because they essentially concerned patients observed in the catheterization laboratory, who were evaluated without strict diagnostic criteria; also, these patients were preselected, because they were mostly referred for diagnostic work-up for signs or symptoms of myocardial ischemia.…”

“…9,10 Only recent novel attempts at screening the general population with echocardiography or magnetic resonance angiography (MRA) have finally established the conditions for improving our knowledge of the denominator in the risk fraction (the number of cases of SCD divided by the number of persons with CAAs in the general population rather than only in autopsy series). 15,[19][20][21][22] Definitive data about CAA-associated mortality are still lacking, because of a lack of studies based on defined and controlled populations. 13 This report attempts to clarify this matter by presenting an overview of more recent and precise approaches to CAA screening, pathophysiology, and clinical evaluation.…”

“…Our method is precise, extensive, and related to a general population (the denominator). 19 It involves the use of an Achieva 1.5 T A-Series scanner with 32-channel coils (Philips, Amsterdam, the Netherlands) in a mobile unit that has been visiting several public middle schools in Houston. In this ongoing study, we do not use any sedation, contrast medium, or medication.…”

“…15,[19][20][21][22] Definitive data about CAA-associated mortality are still lacking, because of a lack of studies based on defined and controlled populations. …”