Abstract 18111: Significance of Delayed Gadolinium Enhancement Cardiac Magnetic Resonance in Patients with Brugada Syndrome

Introduction- Gadlinium-enhanced Cardiac magnetic resonance (CMR) is a useful diagnostic tool for evaluating myocardial abnormality in several diseases. However, the prevalence of delyed Gadlinium enhancement (DGE) in CMR has not been yet reported in patients with Brugada syndrome (BrS). Methods- Seventy consecutive patients with BrS who underwent Gadlinium-enhanced CMR were evaluated in this study. All patients underwent echocardiography and signal-averaged electrocardiography (SAECG). Forty six patients underwent both ventriculography and electrophysiologic study, and 26 patients received mutation analysis of SCN5A. Results- DGE was found in five patients (7.1 %). All patients with DGE were symptomatic. Early repolarization (ER) in inferolateral leads was significantly highly detected in patients with DGE than without DGE (80.0% vs 16.9%, P<0.01). Late potentials examined with SAECG were present in all patients with DGE and in 42 of 65 patients without DGE (64.6%). The value of RMS40 evaluated with SAECG was significantly smaller in patients with DGE than in patients without DGE (p<0.0001). CMR, echocardiography, and both ventriculography failed to show apparent abnormalities of chamber dimensions and wall motion in any patients. In electrophysiologic study, VF was induced with programmed ventricular stimulation in four of five patients with DGE (80.0%) and in 21 of 41 patients without DGE (51.2%). Mutation analysis revealed that DGE was present in one patient with SCN5A mutation and in 2 patients without SCN5A mutation. Conclusions- This is the first report that CMR with DGE can identify abnormal myocardium which is undetectable with other methods in some cases with BrS. Depolarization abnormality is prominent in BrS patients with DGE. Because the positive predictive value of DGE is high, CMR with DGE might be a useful tool for evaluating high risk patient with BrS.