Imaging Findings
Advances in cardiac imaging, in particular using Cardiovascular Magnetic
Resonance (CMR) scanning, has given clinicians the ability to improve
the quality of care for patients with CS. A recent 2022 study concluded
that it was patients with late gadolinium enhancement (LGE) on CMR who
most frequently received appropriate therapy, and moreover that all 10
patients without LGE did not receive appropriate ICD therapy. This
association between appropriate therapy and LGE distribution was seen
most strongly in those with uptake in the area of the right ventricle
(RV), but also in the anterior and inferior walls. Involvement of the RV
in CS predicts both poor outcome, but also high rates of
arrhythmia(25–27). It is this scarring pattern that likely accounts for
the high levels of appropriate therapy seen in this cohort – a theory
evidenced in a study from Schuller et al. (OR 6.73, 95% CI 2.69–16.8,
P < 0.01)(7).
Although there is an association between18F-flourodeoxyglucose positron emission tomography
(FDG-PET) and Major Adverse Cardiovascular Events (MACE) (Citation
needed here), to our knowledge there was no research available that
connected a positive finding on this imaging modality and appropriate
therapy. This is perhaps a gap in the literature that future research
should address.