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.