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Cardiac MRI after Sudden Cardiac Arrest: A Systematic Review
Bernhard Scharinger1, Elke Boxhammer1, Richard Rezar1
1From the Department of Radiology (B. Scharinger, S.H., K.H., R.K.), Department of Internal Medicine II, Division of Cardiology (E.B., R.R., T.W., M.L., U.C.H., B. Strohmer), and Center for Public Health and Healthcare Research (B.W.), Paracelsus Medical University, 5110 Oberndorf, 5020 Salzburg, Austria; and Department of Internal Medicine, General Hospital of Oberndorf, Oberndorf, Austria (S.W., B.W.).
Abstract:
Purpose To perform a systematic review to assess the diagnostic and prognostic value of cardiac MRI after sudden cardiac arrest (SCA). Materials and Methods PubMed and Cochrane Library databases were systematically searched for studies investigating cardiac MRI after SCA in adult patients (≥18 years of age). The time frame of the encompassed studies spans from January 2012 to January 2023. The study protocol was preregistered in OSF Registries (www.osf.io/nxaev), and the systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa quality assessment scale. Results Fourteen studies involving 1367 individuals, 1257 (91.9%) of whom underwent cardiac MRI, were included. Inconsistent findings were reported on the diagnostic value of cardiac MRI-specific findings. The included studies demonstrated the following main findings: (a) cardiac MRI led to a new or alternative diagnosis in patients with SCA; (b) cardiac MRI identified pathologic or arrhythmogenic substrates; (c) cardiac MRI helped detect myocardial edema (potentially reversible); (d) cardiac MRI provided evidence for the occurrence of adverse events; and (e) functional markers or ventricular dimensions were considered prognostically relevant in a few studies. Relevant challenges in this systematic review were the lack of comparators and reference standards relative to cardiac MRI as the index test and patient selection bias. Conclusion Cardiac MRI following SCA can contribute to the diagnostic process and offer supplementary information essential for treatment planning. Limitations of the review include studies with insufficient comparators and potential bias in patient selection. Systematic review registration link: osf.io/nxaev Keywords: Cardiac MRI, Cardiovascular Disease, Cardiomyopathy, Ischemia, Myocardial Edema, Sudden Cardiac Arrest © RSNA, 2024.
Insights
Cardiac MRI after sudden cardiac arrest (SCA) aids diagnosis by identifying substrates and edema. It offers valuable prognostic information but faces limitations in study comparators and patient selection bias.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Medicine
- Prognostic Biomarkers
Background:
- Sudden cardiac arrest (SCA) necessitates accurate diagnostic and prognostic tools.
- Cardiac magnetic resonance imaging (Cardiac MRI) is increasingly explored for its role post-SCA.
Approach:
- Systematic review of studies from January 2012 to January 2023.
- Inclusion of 14 studies involving 1367 adult patients.
- Adherence to PRISMA guidelines and quality assessment using Newcastle-Ottawa scale.
Key Points:
- Cardiac MRI identified new diagnoses, pathological substrates, and myocardial edema in SCA patients.
- Functional markers and ventricular dimensions showed some prognostic relevance.
- Challenges included lack of comparators, reference standards, and potential patient selection bias.
Conclusions:
- Cardiac MRI provides crucial supplementary information for diagnosing and managing patients post-SCA.
- Despite limitations, its role in treatment planning is significant.
