Author + information
- Ashish Aneja, MBBS∗ ()
- ↵∗Cardiovascular Medicine, Case Western Reserve University, MetroHealth Campus, 2500 MetroHealth Drive, Cleveland, Ohio 44109
I read with great interest the manuscript “Late Gadolinium Enhancement Among Survivors of Sudden Cardiac Arrest” (1). This paper offers the best available guidance on the management of this complex group of patients, which we recently utilized in the management of one of the patients admitted to our hospital. As someone who performs cardiac magnetic resonance imaging, I am often confronted by the inability to distinguish between active myocarditis and cardiac sarcoidosis, especially when the ventricles do not exhibit gross structural abnormalities. I find the delayed gadolinium enhancement pattern alone insufficient in distinguishing between these conditions unless extra-cardiac sarcoidosis is manifest.
Perhaps this distinction is moot since late gadolinium enhancement turns out to be the single best predictor of future appropriate implantable cardioverter-defibrillator therapy. On the other hand, this may be important because treatment for sarcoidosis may be available. Additionally, a clear definition of the mechanisms/disease that leads to sudden cardiac death is important from the epidemiologic point of view. Therefore, it would be helpful for the investigators to highlight the methods utilized to distinguish between these conditions.
Please note: Dr. Aneja has reported that he has no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation