Global myocardial oedema in resuscitated out-of-hospital cardiac arrest patients assessed by cardiac magnetic resonance: a pilot study

Abstract

Background Myocardial dysfunction is well described after out-of-hospital cardiac arrest (OHCA), however, the underlying mechanisms are not yet understood. We hypothesised that this dysfunction is associated to a global myocardial oedema. Using cardiac magnetic resonance (CMR), we assessed the presence of such oedema early after successful resuscitation from OHCA. Methods Comatose patients resuscitated from OHCA and admitted to the cardiac intensive care unit were consecutively included and underwent CMR in general anaesthesia within 36 hours after cardiac arrest with anaesthetic support. To assess global myocardial oedema, T1 and T2 segmented maps were generated from three representative short axis slices, and values from each segment were then used to determine a mean global T1 and T2 time for each patient. Healthy subjects were used as controls. Results CMR was obtained in 16 patients and compared to 9 controls. The OHCA patients were 60 ± 9 years old, and acute myocardial infarction was diagnosed in 6 cases. On admission, left ventricular ejection fraction assessed by transthoracic echocardiography was 35 ± 15%, and this improved significantly to 43 ± 14% during hospitalisation (p < 0.05). Mean global T1 and T2 time was significantly higher in OHCA patients compared to the control group (1071 ms vs. 999 ms, p = 0.002, and 52 ms vs. 46 ms, p < 0.001, respectively), and this difference remained significant when segments involved in the myocardial infarction were excluded. Conclusion Assessed with CMR, we for the first time document an early global myocardial oedema in patients successfully resuscitated from OHCA.

Cardiac Magnetic Resonance—Detected Acute Myocardial Edema as Predictor of Favourable Prognosis: A Comprehensive Review

“…Recent studies pointed to the presence of AME in patients with resuscitated out of hospital cardiac arrest (OHCA) [ 46 ]. The pattern of distribution of edema varies upon the underlying conditions and has diagnostic implications.…”