The Role of T1 and T2 Mapping on Cardiovascular Magnetic Resonance Imaging in Sudden Cardiac Arrest Survivors

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We sought to assess the diagnostic role of myocardial parametric mapping using cardiovascular magnetic resonance (CMR) in identifying SCA etiology. Methods Consecutive SCA survivors undergoing CMR with myocardial parametric mapping were included in the study. The determination if CMR was decisive or contributory in identifying SCA etiology was made if the diagnosis was unclear prior to CMR, and the discharge diagnosis was consistent with the CMR result. Parametric mapping was considered essential for the CMR diagnosis if the SCA etiology could have not been determined without its utilization, and contributory if the diagnosis could have been potentially based on the combination of cine and LGE imaging, without optimal assessment of the severity and prognosis of the disease (offered by parametric mapping). Results Of the 35 patients (mean age 46.9 ± 14.1 years; 57% males) included, diagnosis was based on CMR in 23 (66%) patients. Of those, parametric mapping was essential for the diagnosis of myocarditis and tako-tsubo cardiomyopathy (11/48%) and contributed to the diagnosis in 10 (43%) additional cases. Conclusion Inclusion of quantitative T1 and T2 parametric mapping in the SCA CMR protocol has the potential to increase diagnostic yield of CMR and further specify SCA etiology, especially myocarditis. CMR performed early after SCA may aid in the decision-making regarding ICD implantation. sudden cardiac arrest cardiovascular magnetic resonance imaging parametric mapping T1 and T2 mapping Figures Figure 1 Figure 2 Introduction Despite best efforts, the etiology of sudden cardiac arrest (SCA) is identified in only 50% of survivors and in less than 30% of those without coronary artery disease (CAD).[ 1 , 2 ]. SCA might be caused by acute and transient electrical instability in the setting of acute myocardial ischemia or myocarditis, ventricular arrhythmia due to presence of ischemic or nonischemic scar, or primary electrical disease[ 3 – 5 ]. Clinical investigations are aimed to establish the SCA cause and its reversibility to facilitate clinical decision making, including insertion of an implantable cardioverter-defibrillator (ICD)[ 3 , 6 ]. While the role of T2-weighted imaging and late gadolinium enhancement (LGE) imaging in cardiac magnetic resonance imaging (CMR) in SCA survivors has been explored, there is limited data on the role of quantitative myocardial T1 and T2 relaxation times[ 2 , 3 , 7 ]. Myocardial parametric mapping can be used to identify myocardial inflammation, edema, and diffuse interstitial expansion, which can aid in diagnosing myocarditis and various inflammatory and non-ischemic cardiomyopathies[ 2 , 8 ]. Quantitative T2 mapping overcomes several limitations of qualitative T2-weighted imaging and provides more accurate evaluation of myocardial edema[ 8 , 9 ]. The combination of quantitative T2 mapping and LGE is crucial for the differentiation between acute and potentially reversible injuries, such as myocarditis or acute ischemia, and chronic irreversible injuries such as chronic infarct or nonischemic scar[ 3 ]. Assessment of interstitial myocardial fibrosis, quantified by extracellular volume fraction (ECV) via T1 mapping, might provide prognostic information in SCA survivors. ECV elevation is associated with adverse outcomes in patients with both ischemic and nonischemic LGE across a spectrum of left ventricular function[ 10 – 13 ]. Importantly, ECV has been shown to be more strongly associated with adverse outcomes than nonischemic LGE, even after adjusting for left ventricle ejection fraction (LVEF)[ 13 ]. Similar associations were found in patients with CAD, dilated cardiomyopathy, and heart failure with preserved ejection fraction[ 12 , 14 – 16 ]. The goal of our study was to evaluate the diagnostic role of T1 and T2 mapping in identifying SCA etiology and personalizing management of SCA survivors. Preliminary assessment of the prognostic role of parametric mapping was also intended. Materials & Methods Patients This is a retrospective cohort study assessing the role of myocardial T1 and T2 mapping in identifying SCA etiology and assessing prognosis. Patients who presented to our institution with SCA of unclear etiology between 2016 and 2019 and underwent CMR within 4 weeks of SCA were included in the study. Patients with an acute ischemic injury and known culprit coronary artery were not included in the analysis. Aborted SCA was defined as ventricular fibrillation or hemodynamically unstable ventricular tachycardia requiring electrical or chemical cardioversion. The study was approved by The Ohio State University’s Institutional Review Board and informed consent was waived. The electronic medical record was reviewed for demographic and clinical data as well as cardiac testing including electrocardiography (ECG), transthoracic echocardiography (TTE), coronary computed tomography angiography (CCTA), and left heart catheterization (LHC). An ischemic evaluation using LHC and CCTA was available in 33 (94%) patients. CMR Image Acquisition & Analysis Clinical CMR images were acquired at 1.5 T (Magnetom Avanto, Siemens Healthineers, Germany) using standardized protocols including cine imaging, pre-contrast & post-contrast T1 mapping, T2 mapping, and LGE imaging[ 17 ]. CMR studies were anonymized and analyzed using Neosoft, LLC (Pewaukee, Wisconsin, United States of America). LV volumes and LVEF were measured from short-axis stacks of cine frames that covered the LV. Native and post-contrast myocardial T1 values were measured within the septum on the mid short axis (SAX) maps, and ECV was calculated using the standard formula[ 18 ]. T1 values were measured within the non-infarcted myocardium in cases with septal infarct scar. Myocardial T2 values were measured in all AHA segments on the mid SAX as well as long axis (vertical, horizontal and 3-chamber long axis) maps when available[ 17 ]. CMR reference values for the myocardium were based on institutionally established normative control data and were as follows: native T1 999 ± 31 ms, ECV 23.8 ± 2.6% and T2 56 ± 2 ms. The presence, pattern, and extent of LGE was assessed by two level 3 trained CMR readers blinded to clinical information. LGE patterns were described as subendocardial, midwall, subepicardial, and transmural. Presence of LGE was reported according to the American Heart Association [AHA] 17-segment model[ 19 ]. The determination if CMR was decisive or contributory in identifying SCA etiology was made if the diagnosis was unclear prior to CMR, and the discharge diagnosis was consistent with the CMR result. Final SCA etiology was obtained from chart review and CMR analysis with confirmation by 2 cardiologists with adjudication by a 3rd author if in disagreement. Myocarditis on CMR was diagnosed using the updated Lake Louise criteria[ 20 ]. We followed the current criteria for defining hypertrophic cardiomyopathy, nonischemic cardiomyopathy, ischemic cardiomyopathy, and takotsubo cardiomyopathy, as published elsewhere[ 21 – 25 ]. Parametric mapping was considered essential for the CMR diagnosis if the SCA etiology could have not been determined without its utilization, and contributory if the diagnosis could have been potentially based on the combination of cine and LGE imaging, without optimal assessment of the severity and prognosis of the disease (offered by parametric mapping). Follow-Up & Outcomes Patient follow-up was performed by review of the vital status and electronic medical record including ICD interrogation and event monitor results. Follow-up duration was calculated from the date of SCA. The primary outcomes were all-cause mortality or heart transplant, and a composite arrhythmic outcomes including sudden death, VF, sustained VT, and appropriate ICD intervention. Statistical Analysis Categorical data are presented as frequency with percentage, and comparison between groups was performed using the chi-square or Fisher's exact test. Continuous variables were presented as mean ± standard deviation (SD) for normal distributions, and median with 25th and 75th percentiles (Q1-Q3) for non-normal distributions. Normality was tested using skewness, kurtosis, visual inspection of the histogram, QQ plot, and Shapiro-Wilk test. Continuous variable comparisons between groups were performed using the Student's t-test or the Mann-Whitney U test as appropriate. Kaplan-Meier survival curves were drawn to assess differences between groups for time to event data. Time zero was defined as the date of CMR study. A Cox regression model was used to assess the relationship of T1 elevation, T2 elevation, LGE presence, and ECV elevation with clinical outcomes. The hazard ratio and incidence rate ratio were presented as mean and 95% confidence interval. A two-sided p value of < 0.05 was considered statistically significant. The statistical analyses were performed using IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., Armonk, N.Y., USA) and R software, version 4.0.3 (The R Foundation, Vienna, Austria). Results Baseline Characteristics A total of 35 patients were included in the analysis (Fig. 1 ). The mean age of the cohort was 46.9 ± 14.1 years, 57% male (Table 1). The most common primary arrhythmia was ventricular fibrillation/ventricular tachycardia in 33 patients (94%) followed by pulseless electrical activity in 2 patients (6%). CMR was performed within a median 5.5 (IQR: 2-7.5) days after the SCA. CMR results CMR findings are summarized in Table 1 for the whole cohort as well as are stratified by the primary outcome of all-cause mortality, heart transplant and arrhythmic outcomes, and detailed CMR data for each patient are presented in Supplemental Table 1. Elevation of T1 was seen in 18 (51%) patients (mean T1 1069 ± 60 ms), ECV in 16 (46%) patients (mean ECV 30 ± 7%), and T2 in 22 (63%) patients (mean T2 65 ± 10 ms). T2 was most frequently elevated in the mid inferolateral wall (12/34%) Fig. 2 ). LGE was present in 32 (91%) patients with a median of 5 (IQR 4–8) left ventricular segments affected (Table 1, Supplemental Table 1). The prevalence of LGE was highest in the basal (66%) to mid inferoseptal wall (63%). Clinical impact of CMR SCA etiology was established based on clinical data, ECG, TTE, CCTA, and LHC in 8 (23%) patients (Fig. 1 , Table 1). CMR provided the most probable SCA etiology in an additional 23 (66%) patients with parametric mapping abnormalities in 21 (60%). Myocarditis (10), hypertrophic cardiomyopathy (4), nonischemic cardiomyopathy (5), ischemic cardiomyopathy (3), and takotsubo cardiomyopathy (1) were found among the 23 patients whose diagnoses were determined by CMR (Table 1, Supplemental Table 1). Parametric mapping was essential for the diagnosis of myocarditis and takotsubo cardiomyopathy in 11 patients and contributed to the diagnosis in an additional 10 patients among the 23 cases with diagnoses determined by CMR. The etiology of SCA remained unknown in 4(11%) patients despite extensive testing including CMR with parametric mapping. Parametric Mapping in Myocarditis In the 10 myocarditis patients, T2 signal elevation (mean highest T2 of 73 ± 12 ms) and LGE were most commonly seen in the inferolateral wall consistent with prior reports (Table 1, Supplemental Table 1, Fig. 2 )[ 20 ]. T1 was elevated in 6 patients (mean T1, 1084 ± 56 ms), ECV in 3 patients (mean ECV, 28.1 ± 5.6%), and left ventricular ejection fraction (LVEF) was depressed (< 50%) in 3 patients. Diagnosis was confirmed with an endomyocardial biopsy in 1 patient. One patient had influenza infection; 8 had troponin elevation (0.76, IQR 0.19–15.5, normal < 0.11 ng/L). Parametric Mapping and in Takotsubo Cardiomyopathy T1 (1044 ms) and ECV (28.1%) were normal in the tako-tsubo cardiomyopathy patient with myocardial edema/inflammation in the mid and apical segments (mean T2, 77 ms) that extended beyond the septal midmyocardial LGE. Parametric Mapping in Other Etiologies of SCA In the 4 patients with hypertrophic cardiomyopathy, native T1 was elevated in 1, and ECV in 2 patients. Two patients demonstrated T2 signal elevation, with LGE most commonly seen in the septum (Table 1, Supplemental Table 1). Native T1 elevation was observed in 4 out of 5 patients with non-ischemic cardiomyopathy, with ECV and T2 being borderline abnormal in 1 patient. Septal and inferolateral walls were the most common locations of nonischemic LGE. CMR based diagnosis of ischemic cardiomyopathy, was associated with native T1 and ECV elevation in 2/3 patients, whereas T2 was elevated in all 3/3 patients. Infarct scar in 2/3 patients corresponded to segments with T2 elevation and extended to other neighboring segments with no evidence of myocardial edema/inflammation. Native T1 was elevated in 2 of 3 patients, and ECV in all 3 patients whose diagnosis of ischemic cardiomyopathy was not based on CMR. CMR of 3/3 patients was noticeable for an infarct scar that corresponded to segments with T2 elevation and extended to other neighboring segments with no evidence of myocardial edema/inflammation. Two out of 5 patients with the primarily electric etiology of SCA (hypokalemia with QT prolongation, Brugada syndrome) presented with T1 and T2 elevation. Myocardial edema/inflammation, when present, was demonstrated in 1–2 AHA segments. ECV elevation was observed in 1 of 5 patients. Among 4 patients with unclear SCA etiology, native T1 was elevated in 1 patient with ECV elevation in 3 patients. There was no evidence of T2 elevation. ICD Implantation ICD was implanted in 29 (83%) patients. ICD was not implanted in 4 (11%) patients due to reversible SCA cause, whereas 2 (6%) patients refused ICD implantation. Primary Outcomes Three (9%) patients were lost to follow-up. Over the median follow-up of 33.1 months (IQR 25.4–43.1) from SCA, 5 (16%) patients died or underwent a heart transplant, and 12 (38%) met the composite arrhythmic outcome (Supplemental Table 2). No significant differences in baseline characteristics, comorbidities, SCA etiology & mechanism as well as CMR parameters were demonstrated between patients that met and did not meet both primary outcomes (Table 1, Supplemental Fig. 2–3). There was no significant association between T1 elevation and all-cause mortality or heart transplant (HR: 3.25, 95% 0.36–29.7, p = 0.30), or arrhythmic outcomes (HR: 1.37, 95% CI: 0.41–4.62, p = 0.61); T2 elevation and all-cause mortality or heart transplant (HR: 1.84, 95% CI:0.19–17.7, p = 0.60), or arrhythmic outcomes (HR: 0.79, 95% CI: 0.24–2.60, p = 0.70); ECV elevation and all-cause mortality or heart transplant (HR: 0.84, 95% CI: 0.14–5.01, p = 0.84), or arrhythmic outcomes (HR: 1.23, 95% CI: 0.39–3.86, p = 0.72); (Supplemental Fig. 1). Discussion We investigated the diagnostic role of myocardial parametric mapping in SCA survivors. Our data confirms and extends previous observations that CMR with parametric mapping has diagnostic value in assessing SCA etiology compared to non-CMR based evaluation[ 3 , 4 ]. We show that parametric mapping was essential for the diagnosis in 11 patients (myocarditis and tako-tsubo) and contributed to and hence clarified the diagnosis in additional 10 patients. Our data also suggests that myocarditis may be an underdiagnosed cause of SCA in adults. We did not find any association between T1, T2, and ECV elevation and primary outcomes of all-cause mortality and heart transplant as well as arrhythmic outcomes. Our findings regarding the diagnostic value of CMR are in agreement with previously published data.[ 3 , 4 ] Prior reports suggest that LVEF alone has limited sensitivity and specificity for predicting SCA, since 80% of SCA occurs in the setting of LVEF > 35%[ 26 ]. In large studies on SCA survivors with inconclusive ischemic evaluation, CMR contributed to the diagnosis in 49–69% and was decisive in 28–30% of cases, depending on the definition of the study group, despite lack of utilization of parametric mapping[ 7 , 27 ]. Similar to our study, dilated cardiomyopathy, myocarditis, ischemic cardiomyopathy, and hypertrophic cardiomyopathy were the most common SCA etiologies, while 31–36% of cases had unclear etiology[ 7 , 27 ]. We further demonstrate that utilization of parametric mapping has potential to decrease the number of cases with unclear etiology of SCA and hence influence clinical decision-making. Myocarditis, a common SCA cause, remains underdiagnosed[ 28 – 33 ]. Since endomyocardial biopsy is not recommended in every case of suspected myocarditis, CMR has become the gold standard non-invasive diagnostic method enabling tissue characterization of the entire myocardium[ 8 , 32 , 34 – 37 ]. The diagnosis of myocardial inflammation is based on updated Lake Louis criteria including T1 and T2 mapping as well as late gadolinium enhancement imaging[ 38 ]. Combination of T2-weighted imaging with LGE imaging in studies on SCA survivors with inconclusive ischemic evaluation, resulted in diagnosing myocarditis in 6–13% of cases[ 27 , 39 ]. Utilization of T2 mapping, that provides more accurate and quantitative assessment of myocardial edema, could potentially explain the higher percentage of myocarditis in our study (28%)[ 8 , 9 ]. T2 mapping contributed to a more certain diagnosis of other etiologies by either excluding myocarditis as a cause of SCA; confirming the diagnosis suspected based on ischemic evaluation and echocardiography as in takotsubo cardiomyopathy; or assessing the acuity and potential reversibility of the process as in MINOCA and ischemic cardiomyopathy[ 8 ]. These results have the potential to influence decisions regarding ICD implantation[ 27 ]. Other studies have also shown that T2 mapping is useful not only for making the diagnosis but also for risk stratification in certain diagnoses[ 8 ]. The degree of T2 elevation is a reliable predictor of major adverse cardiac events and heart failure hospitalization in patients with myocarditis[ 8 , 35 ]. T2 elevation in hypertrophic cardiomyopathy can be used as a marker for arrhythmogenicity, and in dilated cardiomyopathy to identify patients with low probability of reverse remodeling [ 8 , 40 ]. ECV elevation, which was present in a significant subset of patients in our study, has been associated with adverse outcomes in various cardiomyopathy[ 11 – 16 , 41 ]. ECV in our population was highest in hypertrophic and ischemic CMP as well as MINOCA patients. We attempted to analyze the prognostic role of parametric mapping aware of the study limitations. Heterogeneity of included SCA etiologies is the most likely explanation of the lack of association between T1, T2, or ECV elevation and primary outcomes in our study. Our study was limited by a small sample size, which got even smaller as specific SCA etiologies were evaluated. Further studies that address specific etiologies of SCA, including our future expanded cohort, may be able to characterize association of parametric mapping abnormalities with outcome. Limitations This is a single center small retrospective study. SCA etiologies were determined based on clinical data, and endomyocardial biopsy was not performed in most cases to confirm CMR-based diagnosis of myocarditis. The accuracy of the endomyocardial biopsy, however, is limited by sampling error due to the patchy nature of the inflammatory process[ 28 , 34 , 42 , 43 ]. Since myocardial edema and inflammation observed on CMR could potentially be secondary to SCA (myocardial necrosis secondary to transient hypoxemia) or cardiopulmonary resuscitation, the data must be analyzed with caution and in correspondence with typical LGE pattern[ 3 , 20 ]. Since myocarditis in our study was diagnosed based on the updated Lake Louis criteria which includes T1 and T2 mapping and LGE, it is unlikely to affect results. Distribution of SCA etiologies is not representative for the general population since only patients who survived SCA and had no clear cause of SCA were included in the study. Small sample size with very small subgroups of each SCA etiology limited analysis of the prognostic utility of parametric mapping. Conclusions To conclude, inclusion of quantitative T1 and T2 parametric mapping in the SCA CMR protocol has the potential to increase diagnostic yield of CMR and further specify SCA etiology, especially myocarditis. CMR performed early after SCA may aid in the decision-making regarding ICD implantation. Further studies are needed to investigate the prognostic role of parametric mapping in SCA survivors. Declarations Disclosures: N/A Acknowledgments: N/A References Carter-Monroe N, Virmani R (2011). Current Trends in the Classification of Sudden Cardiac Death Based on Autopsy Derived Data: A Review of Investigations Into the Etiology of Sudden Cardiac Death. Revista Española de Cardiología (English Edition) 64(1):10–2. doi: 10.1016/j.recesp.2010.09.004. Zareba W, Zareba KM (2017). Cardiac Magnetic Resonance in Sudden Cardiac Arrest Survivors. Circ Cardiovasc Imaging. doi: 10.1161/CIRCIMAGING.117.007290. Zorzi A, Susana A, de Lazzari M, Migliore F, Vescovo G, Scarpa D, et al (2018). Diagnostic value and prognostic implications of early cardiac magnetic resonance in survivors of out-of-hospital cardiac arrest. Heart Rhythm 15(7):1031–41. doi: 10.1016/j.hrthm.2018.02.033. Ojrzyńska-Witek N, Marczak M, Mazurkiewicz Ł, Petryka-Mazurkiewicz J, Miłosz-Wieczorek B, Grzybowski J, et al (2022). Sudden cardiac arrest: Focus on cardiac magnetic resonance. Kardiol Pol 80(1):87–9. DOI: 10.33963/KP.a2021.0151. Zaremba T, Brøndberg AK, Jensen HK, Kim WY (2018). Cardiac magnetic resonance characteristics in young survivors of aborted sudden cardiac death. Eur J Radiol 105:141–7. doi: 10.1016/j.ejrad.2018.06.004. Swoboda P, Kidambi A, Uddin A, McDiarmid A, Ripley D, Greenwood J, et al (2014). Cardiovascular Magnetic Resonance is Valuable in the Investigation of Aborted Sudden Cardiac Death. Heart 100(Suppl 3):A71.2-A72. doi: 10.1136/heartjnl-2014-306118.125 Rodrigues P, Joshi A, Williams H, Westwood M, Petersen SE, Zemrak F, et al (2017). Diagnosis and Prognosis in Sudden Cardiac Arrest Survivors Without Coronary Artery Disease: Utility of a Clinical Approach Using Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging Dec;10(12):e006709. doi: 10.1161/CIRCIMAGING.117.006709. O’Brien AT, Gil KE, Varghese J, Simonetti OP, Zareba KM (2022). T2 mapping in myocardial disease: a comprehensive review. Journal of Cardiovascular Magnetic Resonance 24,33. doi: 10.1186/s12968-022-00866-0. Giri S, Chung YC, Merchant A, Mihai G, Rajagopalan S, Raman S v., et al (2009). T2 quantification for improved detection of myocardial edema. Journal of Cardiovascular Magnetic Resonance 11(1):56. doi: 10.1186/1532-429X-11-56. Wong TC, Piehler KM, Kang IA, Kadakkal A, Kellman P, Schwartzman DS, et al (2014). Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J 35(10):657–64. doi: 10.1093/eurheartj/eht193. Schelbert EB, Piehler KM, Zareba KM, Moon JC, Ugander M, Messroghli DR, et al (2015). Myocardial fibrosis quantified by extracellular volume is associated with subsequent hospitalization for heart failure, death, or both across the spectrum of ejection fraction and heart failure stage. J Am Heart Assoc 4(12). doi: 10.1161/JAHA.115.002613. Cheng RK, Masri SC (2019). Extracellular Volume as an Imaging Biomarker for Incident Heart Failure. Circ Cardiovasc Imaging 12(12):10152. doi: 10.1161/CIRCIMAGING.119.010152. Schelbert EB, Piehler KM, Zareba KM, Moon JC, Ugander M, Messroghli DR, et al (2015). Myocardial Fibrosis Quantified by Extracellular Volume Is Associated With Subsequent Hospitalization for Heart Failure, Death, or Both Across the Spectrum of Ejection Fraction and Heart Failure Stage. J Am Heart Assoc 4(12). doi: 10.1161/JAHA.115.002613. Laohabut I, Songsangjinda T, Kaolawanich Y, Yindeengam A, Krittayaphong R (2021). Myocardial Extracellular Volume Fraction and T1 Mapping by Cardiac Magnetic Resonance Compared Between Patients With and Without Type 2 Diabetes, and the Effect of ECV and T2D on Cardiovascular Outcomes. Front Cardiovasc Med 7;0:1725. doi: 10.3389/fcvm.2021.771363. Youn JC, Hong YJ, Lee HJ, Han K, Shim CY, Hong GR, et al (2017). Contrast-enhanced T1 mapping-based extracellular volume fraction independently predicts clinical outcome in patients with non-ischemic dilated cardiomyopathy: a prospective cohort study. Eur Radiol 27(9):3924–33. doi: 10.1007/s00330-017-4817-9. Schelbert EB, Fridman Y, Wong TC, Abu Daya H, Piehler KM, Kadakkal A, et al (2017). Temporal Relation Between Myocardial Fibrosis and Heart Failure With Preserved Ejection Fraction: Association With Baseline Disease Severity and Subsequent Outcome. JAMA Cardiol 2(9):995–1006. doi: 10.1001/jamacardio.2017.2511. Kramer CM, Barkhausen J, Bucciarelli-Ducci C, Flamm SD, Kim RJ, Nagel E (2020). Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. Journal of Cardiovascular Magnetic 22(1):1–18. https://doi.org/10.1186/s12968-020-00607-1. Haaf P, Garg P, Messroghli DR, Broadbent DA, Greenwood JP, Plein S (2016). Cardiac T1 Mapping and Extracellular Volume (ECV) in clinical practice: A comprehensive review. Journal of Cardiovascular Magnetic Resonance 18(1):1–12. doi: 10.1186/s12968-016-0308-4. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al (2002). Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart. Circulation 105(4):539–42. doi: 10.1161/hc0402.102975. Aquaro GD, Perfetti M, Camastra G, Monti L, Dellegrottaglie S, Moro C, et al (2017). Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function: ITAMY Study. J Am Coll 70(16):1977–87. doi: 10.1016/j.jacc.2017.08.044. Maron BJ, Maron MS (2016). LGE Means Better Selection of HCM Patients for Primary Prevention Implantable Defibrillators. JACC: Cardiovascular Imaging 9 (12) 1403–1406.https://doi.org/10.1016/j.jcmg.2016.01.032. Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, et al (2016). Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement from the American Heart Association. Circulation 134:e579–e646. https://doi.org/10.1161/CIR.0000000000000455. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al (2006). Contemporary definitions and classification of the cardiomyopathies: An American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 113(14):1807–16. doi: 10.1161/CIRCULATIONAHA.106.174287. Singh T, Khan H, Gamble DT, Scally C, Newby DE, Dawson D (2022). Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications. Circulation 145(13):1002–19. doi: 10.1161/CIRCULATIONAHA.121.055854. Thavendiranathan P, Walls M, Giri S, Verhaert D, Rajagopalan S, Moore S, et al (2012). Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping. Circ Cardiovasc Imaging 5(1):102–10. doi: 10.1161/CIRCIMAGING.111.967836. Wu KC (2017). Sudden Cardiac Death Substrate Imaged by Magnetic Resonance Imaging: From Investigational Tool to Clinical Applications. Circ Cardiovasc Imaging 10(7):e005461. doi: 10.1161/CIRCIMAGING.116.005461. Baritussio A, Zorzi A, Ghosh Dastidar A, Susana A, Mattesi G, Rodrigues JCL, et al (2017). Out of hospital cardiac arrest survivors with inconclusive coronary angiogram: Impact of cardiovascular magnetic resonance on clinical management and decision-making. Resuscitation 116:91–7. doi: 10.1016/j.resuscitation.2017.03.039. Tschöpe C, Ammirati E, Bozkurt B, Caforio ALP, Cooper LT, Felix SB, et al (2021). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol 18(3):169-193. doi: 10.1038/s41569-020-00435-x. von Knobelsdorff-Brenkenhoff F, Schüler J, Dogangüzel S, Dieringer MA, Rudolph A, Greiser A, et al (2017). Detection and Monitoring of Acute Myocarditis Applying Quantitative Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 10(2):1–10. doi: 10.1161/CIRCIMAGING.116.005242. Grun S, Schumm J, Greulich S, Wagner A, Schneider S, Bruder O, et al (2012). Long-term follow-up of biopsy-proven viral myocarditis: Predictors of mortality and incomplete recovery. J Am Coll Cardiol 59(18):1604–15. doi: 10.1016/j.jacc.2012.01.007. Spieker M, Katsianos E, Gastl M, Behm P, Horn P, Jacoby C, et al (2018). T2 mapping cardiovascular magnetic resonance identifies the presence of myocardial inflammation in patients with dilated cardiomyopathy as compared to endomyocardial biopsy. Eur Heart J Cardiovasc Imaging 19(5):574–82. doi: 10.1093/ehjci/jex230. Løgstrup BB, Nielsen JM, Kim WY, Poulsen SH (20160. Myocardial oedema in acutemyocarditis detected by echocardiographic 2Dmyocardial deformation analysis. Eur Heart J Cardiovasc Imaging 17(9):1018–26. doi: 10.1093/ehjci/jev302. Ruppert V, Meyer T, Pankuweit S, Möller E, Funck RC, Grimm W, et al (2008). Gene expression profiling from endomyocardial biopsy tissue allows distinction between subentities of dilated cardiomyopathy. Journal of Thoracic and Cardiovascular Surgery 136(2): 360-369.e1. doi: 10.1016/j.jtcvs.2008.03.016 Ammirati E, Frigerio M, Adler ED, Basso C, Birnie DH, Brambatti M, et al (2020). Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ Heart Fail 13(11):e007405. doi: 10.1161/CIRCHEARTFAILURE.120.007405. Spieker M, Haberkorn S, Gastl M, Behm P, Katsianos S, Horn P, et al (2017). Abnormal T2 mapping cardiovascular magnetic resonance correlates with adverse clinical outcome in patients with suspected acute myocarditis. Journal of Cardiovascular Magnetic Resonance 19(1): 38. doi: 10.1186/s12968-017-0350-x. P Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. 34(33):2636-48, 2648a-2648d. doi: 10.1093/eurheartj/eht210. Dass S, Suttie JJ, Piechnik SK, Ferreira VM, Holloway CJ, Banerjee R, et al (2012). Myocardial tissue characterization using magnetic resonance noncontrast T1 mapping in hypertrophic and dilated cardiomyopathy. Circ Cardiovasc Imaging 5(6):726–33. doi: 10.1161/CIRCIMAGING.112.976738. Ferreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, et al (2018). Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol 72(24):3158–76. doi: 10.1016/j.jacc.2018.09.072. Rodrigues P, Joshi A, Williams H, Westwood M, Petersen SE, Zemrak F, et al (2017). Diagnosis and Prognosis in Sudden Cardiac Arrest Survivors Without Coronary Artery Disease: Utility of a Clinical Approach Using Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 10(12):e006709. doi: 10.1161/CIRCIMAGING.117.006709. Baig M, Galazka P, Dakwar O, Syed SA, Sawlani R, Shahir K, et al (2021). Prevalence of myocardial edema with T2 mapping in hypertrophic cardiomyopathy. J Am Coll Cardiol 77 (18_Supplement_1):1303.https://doi.org/10.1016/S0735-1097(21)02661-9 Wong TC, Piehler KM, Kang IA, Kadakkal A, Kellman P, Schwartzman DS, et al (2014). Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J 35(10):657–64. doi: 10.1093/eurheartj/eht193. Bönner F, Spieker M, Haberkorn S, Jacoby C, Flögel U, Schnackenburg B, et al. Myocardial T2 Mapping Increases Noninvasive Diagnostic Accuracy for Biopsy-Proven Myocarditis. JACC: Cardiovascular Imaging 9:1467–9. doi: 10.1016/j.jcmg.2015.11.014. Lurz P, Luecke C, Eitel I, Föhrenbach F, Frank C, Grothoff M, et al (2016). Comprehensive Cardiac Magnetic Resonance Imaging in Patients with Suspected Myocarditis the MyoRacer-Trial. J Am Coll Cardiol 67(15):1800–11. doi: 10.1016/j.jacc.2016.02.013. Table 1 Table 1. Baseline clinical and imaging characteristics of Sudden Cardiac Arrest Survivors. Abbreviations: BSA - body surface area; SCA – sudden cardiac arrest; MINOCA - myocardial infarction with non-obstructive coronary arteries; CMR – cardiovascular magnetic resonance; LVEDVI – left ventricular end-diastolic volume index; LVESVI - left ventricular end-systolic volume index; LVEF – left ventricular ejection fraction; LGE – late gadolinium enhancement imaging; AHA – American Heart Association. Continuous variables are expressed as mean ± standard deviation with normal distribution and median and interquartile range (25th-75th percentiles) with non-normal distribution. Categorical variables are presented as n (%). *Calculated from the cohort having primary outcome data (all-cause mortality, heart transplant and arrhythmic outcomes) Characteristic Whole cohort (n=35) Primary Outcome* P value Yes (n=15) No (n=17) Age, mean (SD), y 46.9 ± 14.1 50.4 ± 15.0 46.1 ± 13.3 0.39 Male, No. (%) 20 (57) 9 (60.0) 8 (47.1) 0.46 BSA, mean (SD), m 2 2.1 ±0.3 2.1 ± 0.4 2.0 ± 0.2 0.32 Obesity, No. (%) 13 (37) 7 (46.7) 5 (29.4) 0.31 Hypertension, No. (%) 24 (69) 13 (86.7) 10 (58.8) 0.12 Hyperlipidemia, No. (%) 14 (40) 6 (40.0) 6 (35.3) 0.78 Diabetes mellitus, No. (%) 6 (17) 2 (13.3) 3 (17.6) 0.99 Atrial fibrillation, No. (%) 6 (17) 2 (13.3) 4 (23.5) 0.66 Coronary artery disease, No. (%) 16 (46) Stroke, No. (%) 4 (11) 2 (13.3) 2 (11.8) 0.99 Chronic kidney disease, No. (%) 4 (11) 2 (13.3) 2 (11.8) 0.99 Chronic obstructive pulmonary disease, No. (%) 2 (6) 2 (13.3) 0 (0.0) 0.21 SCA m echanism, No. (%) Ventricular fibrillation/ventricular tachycardia 33 (94) 14 (93.3) 16 (94.1) 0.99 Pulseless electrical activity 2 (6) 1 (6.7) 1 (5.9) 0.99 Suspected SCA etiology, No. (%) 0.65 Suspected SCA etiology by CMR, No. (%) Myocarditis (parametric mapping essential for the diagnosis) 10 (29) 4 (27) 5 (29) Hypertrophic cardiomyopathy 4 (11) 1 (7) 3 (18) Non-ischemic cardiomyopathy 5 (14) 2 (13) 3 (18) Ischemic cardiomyopathy 3 (9) 3 (20.0) 0 (0.0) Tako-tsubo cardiomyopathy (parametric mapping essential for the diagnosis) 1 (3) 0 (0) 1 (6) Suspected SCA etiology based on other tests, No. (%) Ischemic cardiomyopathy 3 (9) 1 (7) 1 (6) Primarily electric etiology 5 (14) 3 (20) 2 (12) Unclear cause 4 (11) 1 (7) 2 (12) CMR parameters, mean (SD) LVEDVI, mean (SD), ml/m2 87 (27) 91 (23) 85 (30) 0.52 LVESVI, mean (SD), ml/m2 51 (25) 55 (25) 49 (27) 0.52 LVEF, mean (SD), %, 49 (13) 46 (14) 52 (13) 0.20 T1 elevation, No. (%) 18 (51%) 10 (66.7) 7 (41.2) 0.15 Mean T1, mean (SD), ms 1069 ± 60 1085 ± 63 1059 ± 57 0.22 ECV, mean (SD), % 30 ± 7 30 ± 7 29 ± 7 0.69 T2 elevation, No. (%) 22 (63%) 9 (60.0) 11 (64.7) 0.78 Mean T2, mean (SD), ms 65 ± 10 64 ± 10 65 ± 11 0.71 LGE presence, No. (%) 32 (91) 13 (86.7) 16 (94.1) 0.59 LGE midwall, No. (%) 24 (69) 8 (53.3) 15 (88.2) 0.03 LGE subepicardial, No. (%) 7 (20) 2 (13.3) 4 (23.5) 0.66 LGE subendocardial, No. (%) 7 (20) 4 (26.7) 2 (11.8) 0.38 LGE transmural, No. (%) 4 (11.4) 3 (20.0) 1 (5.9) 0.32 AHA segments, median (IQR) 5 (4-8) 4 (3-7) 5 (4-10) 0.22 Additional Declarations No competing interests reported. Supplementary Files SupplementSCAmappingfinal.docx Cite Share Download PDF Status: Published Journal Publication published 05 May, 2023 Read the published version in The International Journal of Cardiovascular Imaging → Version 1 posted Editorial decision: Major revision 03 Apr, 2023 Reviews received at journal 03 Apr, 2023 Reviews received at journal 25 Mar, 2023 Reviewers agreed at journal 18 Mar, 2023 Reviewers agreed at journal 18 Mar, 2023 Reviewers invited by journal 03 Mar, 2023 Editor assigned by journal 02 Mar, 2023 Submission checks completed at journal 02 Mar, 2023 First submitted to journal 01 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2643647","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":180428910,"identity":"71c76a22-74a3-4fdf-8070-2550b714e63a","order_by":0,"name":"Katarzyna Elżbieta Gil","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYBACCWTOgQcVMCYbPi3MSFoSzpCqhSGxjQgtku3nD36u+HM4j7+B/eKBxHk29gbXDj9g+FB2GKcWaZ5kZskzPIeLJQ7wFBxI3JaWuOF2mgHjjHO4tcgxJDNINkgcTmw4wJMA1HI4weB2DgMzbxseLfyPmX82GBxOnA/WMuewPVjLXzxapCWS2SQbEg4nbjjAfuBAYsNhxg0gLYx4tEjOeGxm2XAgPXHjYR5gIB9LS5wJ9MvBnnPpOLVInE98fLPhj3XivOPtjz98qLGx57ud/PDBjzJrnFqgoJmBgZnHAM49QEg9ENQBMfsDIhSOglEwCkbBSAQAY4NeKutHK9gAAAAASUVORK5CYII=","orcid":"","institution":"Division of Cardiovascular Medicine, The Ohio State University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Katarzyna","middleName":"Elżbieta","lastName":"Gil","suffix":""},{"id":180428911,"identity":"de4de7fa-4137-49ec-8077-55e1e0c09c59","order_by":1,"name":"Vien T Truong","email":"","orcid":"","institution":"Department of Internal Medicine, Nazareth Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Vien","middleName":"T","lastName":"Truong","suffix":""},{"id":180428912,"identity":"127810ba-4d78-47e6-a393-a6ffd2dcd8d3","order_by":2,"name":"Karolina M Zareba","email":"","orcid":"","institution":"Division of Cardiovascular Medicine, The Ohio State University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Karolina","middleName":"M","lastName":"Zareba","suffix":""},{"id":180428914,"identity":"7dc87ab3-ef56-4a19-916b-646caca14955","order_by":3,"name":"Juliet Varghese","email":"","orcid":"","institution":"Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Juliet","middleName":"","lastName":"Varghese","suffix":""},{"id":180428916,"identity":"6b134126-4720-429f-bb46-cf67f5134cbe","order_by":4,"name":"Orlando P Simonetti","email":"","orcid":"","institution":"Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Orlando","middleName":"P","lastName":"Simonetti","suffix":""},{"id":180428919,"identity":"94d860ad-7126-497c-b730-782dad4570ae","order_by":5,"name":"Saurabh Rajpal","email":"","orcid":"","institution":"Division of Cardiovascular Medicine, The Ohio State University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Saurabh","middleName":"","lastName":"Rajpal","suffix":""}],"badges":[],"createdAt":"2023-03-01 14:44:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2643647/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2643647/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10554-023-02864-4","type":"published","date":"2023-05-05T20:41:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":33908951,"identity":"b38a22f5-b637-4a38-97ec-38a87e77d84c","added_by":"auto","created_at":"2023-03-07 15:17:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27305,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow diagram of the analyzed studies.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCMR – cardiovascular magnetic resonance; SCA – sudden cardiac arrest; CAD – coronary artery disease; HCM – hypertrophic cardiomyopathy; NICM – nonischemic cardiomyopathy; ECG – electrocardiogram; TTE – transthoracic echocardiography; CCTA – coronary computed tomography angiography; LHC – left heart catheterization.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2643647/v1/c609745c694161a626af25af.png"},{"id":33908952,"identity":"3b41c215-9837-447e-aff9-c4ac3725acbb","added_by":"auto","created_at":"2023-03-07 15:17:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1244265,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCardiovascular Magnetic Resonance Findings in Sudden Cardiac Death Survivors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eT1 mapping: \u003c/strong\u003ePanel A (mid short axis map view); \u003cstrong\u003eT2 mapping:\u003c/strong\u003e Panel B (mid short axis map view), C (horizontal long axis view), D (vertical long axis view); \u003cstrong\u003eLate gadolinium enhancement imaging:\u003c/strong\u003e Panel E (mid short axis map view), F (horizontal long axis view), G (vertical long axis view).\u003cstrong\u003e\u003cbr\u003e\nPanel 1, 68-year-old male: \u003c/strong\u003eT1 signal elevation (Panel 1A; white arrows) (1127 ms; site specific normal \u0026lt;1060 ms), extensive myocardial edema/inflammation (Panel 2A; black arrows) (up to 92 ms in the anterior wall; site specific normal \u0026lt;60 ms) with corresponding prominent midmyocardial-subepicardial nonischemic fibrosis in the anterior, inferior, and lateral walls (Panel 3A-C; white arrows).\u003cbr\u003e\n\u003cstrong\u003ePanel 2, 55-year-old male: \u003c/strong\u003eNontransmural infarct scar in the septal and inferior walls (Panel 3A-C; white arrows), T1 signal elevation (Panel 1A; white arrows) (1159 ms) and corresponding myocardial edema/inflammation on T2 mapping (Panel 2A; black arrows) (up to 69 ms in the septal wall).\u003cbr\u003e\n\u003cstrong\u003ePanel 3, 58-year-old female: \u003c/strong\u003eNormal native T1 values (Panel 1A) with no evidence of myocardial edema/inflammation (Panel 2A) and mild non-specific midwall non-ischemic fibrosis (Panel 3A-C; white arrows).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-2643647/v1/a5dc822b314b50616f065117.png"},{"id":44729337,"identity":"dc3eed40-254d-4796-9eea-c27f424ca96b","added_by":"auto","created_at":"2023-10-16 21:14:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1611353,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2643647/v1/1ff36263-aa68-43d2-bc04-3ee434fdb470.pdf"},{"id":33908953,"identity":"96d133c9-04bf-41ca-a3b6-fbad551e5347","added_by":"auto","created_at":"2023-03-07 15:17:30","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":654559,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementSCAmappingfinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-2643647/v1/be837af62cd3ad7cbbd623cf.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Role of T1 and T2 Mapping on Cardiovascular Magnetic Resonance Imaging in Sudden Cardiac Arrest Survivors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite best efforts, the etiology of sudden cardiac arrest (SCA) is identified in only 50% of survivors and in less than 30% of those without coronary artery disease (CAD).[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. SCA might be caused by acute and transient electrical instability in the setting of acute myocardial ischemia or myocarditis, ventricular arrhythmia due to presence of ischemic or nonischemic scar, or primary electrical disease[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Clinical investigations are aimed to establish the SCA cause and its reversibility to facilitate clinical decision making, including insertion of an implantable cardioverter-defibrillator (ICD)[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile the role of T2-weighted imaging and late gadolinium enhancement (LGE) imaging in cardiac magnetic resonance imaging (CMR) in SCA survivors has been explored, there is limited data on the role of quantitative myocardial T1 and T2 relaxation times[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Myocardial parametric mapping can be used to identify myocardial inflammation, edema, and diffuse interstitial expansion, which can aid in diagnosing myocarditis and various inflammatory and non-ischemic cardiomyopathies[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eQuantitative T2 mapping overcomes several limitations of qualitative T2-weighted imaging and provides more accurate evaluation of myocardial edema[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The combination of quantitative T2 mapping and LGE is crucial for the differentiation between acute and potentially reversible injuries, such as myocarditis or acute ischemia, and chronic irreversible injuries such as chronic infarct or nonischemic scar[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAssessment of interstitial myocardial fibrosis, quantified by extracellular volume fraction (ECV) via T1 mapping, might provide prognostic information in SCA survivors. ECV elevation is associated with adverse outcomes in patients with both ischemic and nonischemic LGE across a spectrum of left ventricular function[\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Importantly, ECV has been shown to be more strongly associated with adverse outcomes than nonischemic LGE, even after adjusting for left ventricle ejection fraction (LVEF)[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similar associations were found in patients with CAD, dilated cardiomyopathy, and heart failure with preserved ejection fraction[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe goal of our study was to evaluate the diagnostic role of T1 and T2 mapping in identifying SCA etiology and personalizing management of SCA survivors. Preliminary assessment of the prognostic role of parametric mapping was also intended.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThis is a retrospective cohort study assessing the role of myocardial T1 and T2 mapping in identifying SCA etiology and assessing prognosis. Patients who presented to our institution with SCA of unclear etiology between 2016 and 2019 and underwent CMR within 4 weeks of SCA were included in the study. Patients with an acute ischemic injury and known culprit coronary artery were not included in the analysis. Aborted SCA was defined as ventricular fibrillation or hemodynamically unstable ventricular tachycardia requiring electrical or chemical cardioversion. The study was approved by The Ohio State University\u0026rsquo;s Institutional Review Board and informed consent was waived.\u003c/p\u003e \u003cp\u003eThe electronic medical record was reviewed for demographic and clinical data as well as cardiac testing including electrocardiography (ECG), transthoracic echocardiography (TTE), coronary computed tomography angiography (CCTA), and left heart catheterization (LHC). An ischemic evaluation using LHC and CCTA was available in 33 (94%) patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eCMR Image Acquisition \u0026amp; Analysis\u003c/h2\u003e \u003cp\u003eClinical CMR images were acquired at 1.5 T (Magnetom Avanto, Siemens Healthineers, Germany) using standardized protocols including cine imaging, pre-contrast \u0026amp; post-contrast T1 mapping, T2 mapping, and LGE imaging[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCMR studies were anonymized and analyzed using Neosoft, LLC (Pewaukee, Wisconsin, United States of America). LV volumes and LVEF were measured from short-axis stacks of cine frames that covered the LV. Native and post-contrast myocardial T1 values were measured within the septum on the mid short axis (SAX) maps, and ECV was calculated using the standard formula[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. T1 values were measured within the non-infarcted myocardium in cases with septal infarct scar. Myocardial T2 values were measured in all AHA segments on the mid SAX as well as long axis (vertical, horizontal and 3-chamber long axis) maps when available[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. CMR reference values for the myocardium were based on institutionally established normative control data and were as follows: native T1 999\u0026thinsp;\u0026plusmn;\u0026thinsp;31 ms, ECV 23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6% and T2 56\u0026thinsp;\u0026plusmn;\u0026thinsp;2 ms.\u003c/p\u003e \u003cp\u003eThe presence, pattern, and extent of LGE was assessed by two level 3 trained CMR readers blinded to clinical information. LGE patterns were described as subendocardial, midwall, subepicardial, and transmural. Presence of LGE was reported according to the American Heart Association [AHA] 17-segment model[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe determination if CMR was decisive or contributory in identifying SCA etiology was made if the diagnosis was unclear prior to CMR, and the discharge diagnosis was consistent with the CMR result. Final SCA etiology was obtained from chart review and CMR analysis with confirmation by 2 cardiologists with adjudication by a 3rd author if in disagreement. Myocarditis on CMR was diagnosed using the updated Lake Louise criteria[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. We followed the current criteria for defining hypertrophic cardiomyopathy, nonischemic cardiomyopathy, ischemic cardiomyopathy, and takotsubo cardiomyopathy, as published elsewhere[\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParametric mapping was considered essential for the CMR diagnosis if the SCA etiology could have not been determined without its utilization, and contributory if the diagnosis could have been potentially based on the combination of cine and LGE imaging, without optimal assessment of the severity and prognosis of the disease (offered by parametric mapping).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eFollow-Up \u0026amp; Outcomes\u003c/h2\u003e \u003cp\u003ePatient follow-up was performed by review of the vital status and electronic medical record including ICD interrogation and event monitor results. Follow-up duration was calculated from the date of SCA. The primary outcomes were all-cause mortality or heart transplant, and a composite arrhythmic outcomes including sudden death, VF, sustained VT, and appropriate ICD intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eCategorical data are presented as frequency with percentage, and comparison between groups was performed using the chi-square or Fisher's exact test. Continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for normal distributions, and median with 25th and 75th percentiles (Q1-Q3) for non-normal distributions. Normality was tested using skewness, kurtosis, visual inspection of the histogram, QQ plot, and Shapiro-Wilk test. Continuous variable comparisons between groups were performed using the Student's t-test or the Mann-Whitney U test as appropriate. Kaplan-Meier survival curves were drawn to assess differences between groups for time to event data. Time zero was defined as the date of CMR study. A Cox regression model was used to assess the relationship of T1 elevation, T2 elevation, LGE presence, and ECV elevation with clinical outcomes. The hazard ratio and incidence rate ratio were presented as mean and 95% confidence interval. A two-sided p value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. The statistical analyses were performed using IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., Armonk, N.Y., USA) and R software, version 4.0.3 (The R Foundation, Vienna, Austria).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e \u003cp\u003eA total of 35 patients were included in the analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age of the cohort was 46.9\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1 years, 57% male (Table\u0026nbsp;1). The most common primary arrhythmia was ventricular fibrillation/ventricular tachycardia in 33 patients (94%) followed by pulseless electrical activity in 2 patients (6%). CMR was performed within a median 5.5 (IQR: 2-7.5) days after the SCA.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eCMR results\u003c/h2\u003e \u003cp\u003eCMR findings are summarized in Table\u0026nbsp;1 for the whole cohort as well as are stratified by the primary outcome of all-cause mortality, heart transplant and arrhythmic outcomes, and detailed CMR data for each patient are presented in Supplemental Table\u0026nbsp;1. Elevation of T1 was seen in 18 (51%) patients (mean T1 1069\u0026thinsp;\u0026plusmn;\u0026thinsp;60 ms), ECV in 16 (46%) patients (mean ECV 30\u0026thinsp;\u0026plusmn;\u0026thinsp;7%), and T2 in 22 (63%) patients (mean T2 65\u0026thinsp;\u0026plusmn;\u0026thinsp;10 ms). T2 was most frequently elevated in the mid inferolateral wall (12/34%) Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). LGE was present in 32 (91%) patients with a median of 5 (IQR 4\u0026ndash;8) left ventricular segments affected (Table\u0026nbsp;1, Supplemental Table\u0026nbsp;1). The prevalence of LGE was highest in the basal (66%) to mid inferoseptal wall (63%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eClinical impact of CMR\u003c/h2\u003e \u003cp\u003eSCA etiology was established based on clinical data, ECG, TTE, CCTA, and LHC in 8 (23%) patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Table\u0026nbsp;1). CMR provided the most probable SCA etiology in an additional 23 (66%) patients with parametric mapping abnormalities in 21 (60%). Myocarditis (10), hypertrophic cardiomyopathy (4), nonischemic cardiomyopathy (5), ischemic cardiomyopathy (3), and takotsubo cardiomyopathy (1) were found among the 23 patients whose diagnoses were determined by CMR (Table\u0026nbsp;1, Supplemental Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eParametric mapping was essential for the diagnosis of myocarditis and takotsubo cardiomyopathy in 11 patients and contributed to the diagnosis in an additional 10 patients among the 23 cases with diagnoses determined by CMR. The etiology of SCA remained unknown in 4(11%) patients despite extensive testing including CMR with parametric mapping.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eParametric Mapping in Myocarditis\u003c/h2\u003e \u003cp\u003eIn the 10 myocarditis patients, T2 signal elevation (mean highest T2 of 73\u0026thinsp;\u0026plusmn;\u0026thinsp;12 ms) and LGE were most commonly seen in the inferolateral wall consistent with prior reports (Table\u0026nbsp;1, Supplemental Table\u0026nbsp;1, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. T1 was elevated in 6 patients (mean T1, 1084\u0026thinsp;\u0026plusmn;\u0026thinsp;56 ms), ECV in 3 patients (mean ECV, 28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6%), and left ventricular ejection fraction (LVEF) was depressed (\u0026lt;\u0026thinsp;50%) in 3 patients. Diagnosis was confirmed with an endomyocardial biopsy in 1 patient. One patient had influenza infection; 8 had troponin elevation (0.76, IQR 0.19\u0026ndash;15.5, normal\u0026thinsp;\u0026lt;\u0026thinsp;0.11 ng/L).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eParametric Mapping and in Takotsubo Cardiomyopathy\u003c/h2\u003e \u003cp\u003eT1 (1044 ms) and ECV (28.1%) were normal in the tako-tsubo cardiomyopathy patient with myocardial edema/inflammation in the mid and apical segments (mean T2, 77 ms) that extended beyond the septal midmyocardial LGE.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eParametric Mapping in Other Etiologies of SCA\u003c/h2\u003e \u003cp\u003eIn the 4 patients with hypertrophic cardiomyopathy, native T1 was elevated in 1, and ECV in 2 patients. Two patients demonstrated T2 signal elevation, with LGE most commonly seen in the septum (Table\u0026nbsp;1, Supplemental Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eNative T1 elevation was observed in 4 out of 5 patients with non-ischemic cardiomyopathy, with ECV and T2 being borderline abnormal in 1 patient. Septal and inferolateral walls were the most common locations of nonischemic LGE.\u003c/p\u003e \u003cp\u003eCMR based diagnosis of ischemic cardiomyopathy, was associated with native T1 and ECV elevation in 2/3 patients, whereas T2 was elevated in all 3/3 patients. Infarct scar in 2/3 patients corresponded to segments with T2 elevation and extended to other neighboring segments with no evidence of myocardial edema/inflammation.\u003c/p\u003e \u003cp\u003eNative T1 was elevated in 2 of 3 patients, and ECV in all 3 patients whose diagnosis of ischemic cardiomyopathy was not based on CMR. CMR of 3/3 patients was noticeable for an infarct scar that corresponded to segments with T2 elevation and extended to other neighboring segments with no evidence of myocardial edema/inflammation.\u003c/p\u003e \u003cp\u003eTwo out of 5 patients with the primarily electric etiology of SCA (hypokalemia with QT prolongation, Brugada syndrome) presented with T1 and T2 elevation. Myocardial edema/inflammation, when present, was demonstrated in 1\u0026ndash;2 AHA segments. ECV elevation was observed in 1 of 5 patients.\u003c/p\u003e \u003cp\u003eAmong 4 patients with unclear SCA etiology, native T1 was elevated in 1 patient with ECV elevation in 3 patients. There was no evidence of T2 elevation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eICD Implantation\u003c/h2\u003e \u003cp\u003eICD was implanted in 29 (83%) patients. ICD was not implanted in 4 (11%) patients due to reversible SCA cause, whereas 2 (6%) patients refused ICD implantation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePrimary Outcomes\u003c/h2\u003e \u003cp\u003eThree (9%) patients were lost to follow-up. Over the median follow-up of 33.1 months (IQR 25.4\u0026ndash;43.1) from SCA, 5 (16%) patients died or underwent a heart transplant, and 12 (38%) met the composite arrhythmic outcome (Supplemental Table\u0026nbsp;2). No significant differences in baseline characteristics, comorbidities, SCA etiology \u0026amp; mechanism as well as CMR parameters were demonstrated between patients that met and did not meet both primary outcomes (Table\u0026nbsp;1, Supplemental Fig.\u0026nbsp;2\u0026ndash;3). There was no significant association between T1 elevation and all-cause mortality or heart transplant (HR: 3.25, 95% 0.36\u0026ndash;29.7, p\u0026thinsp;=\u0026thinsp;0.30), or arrhythmic outcomes (HR: 1.37, 95% CI: 0.41\u0026ndash;4.62, p\u0026thinsp;=\u0026thinsp;0.61); T2 elevation and all-cause mortality or heart transplant (HR: 1.84, 95% CI:0.19\u0026ndash;17.7, p\u0026thinsp;=\u0026thinsp;0.60), or arrhythmic outcomes (HR: 0.79, 95% CI: 0.24\u0026ndash;2.60, p\u0026thinsp;=\u0026thinsp;0.70); ECV elevation and all-cause mortality or heart transplant (HR: 0.84, 95% CI: 0.14\u0026ndash;5.01, p\u0026thinsp;=\u0026thinsp;0.84), or arrhythmic outcomes (HR: 1.23, 95% CI: 0.39\u0026ndash;3.86, p\u0026thinsp;=\u0026thinsp;0.72); (Supplemental Fig.\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe investigated the diagnostic role of myocardial parametric mapping in SCA survivors. Our data confirms and extends previous observations that CMR with parametric mapping has diagnostic value in assessing SCA etiology compared to non-CMR based evaluation[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. We show that parametric mapping was essential for the diagnosis in 11 patients (myocarditis and tako-tsubo) and contributed to and hence clarified the diagnosis in additional 10 patients. Our data also suggests that myocarditis may be an underdiagnosed cause of SCA in adults. We did not find any association between T1, T2, and ECV elevation and primary outcomes of all-cause mortality and heart transplant as well as arrhythmic outcomes.\u003c/p\u003e \u003cp\u003eOur findings regarding the diagnostic value of CMR are in agreement with previously published data.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Prior reports suggest that LVEF alone has limited sensitivity and specificity for predicting SCA, since 80% of SCA occurs in the setting of LVEF\u0026thinsp;\u0026gt;\u0026thinsp;35%[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In large studies on SCA survivors with inconclusive ischemic evaluation, CMR contributed to the diagnosis in 49\u0026ndash;69% and was decisive in 28\u0026ndash;30% of cases, depending on the definition of the study group, despite lack of utilization of parametric mapping[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Similar to our study, dilated cardiomyopathy, myocarditis, ischemic cardiomyopathy, and hypertrophic cardiomyopathy were the most common SCA etiologies, while 31\u0026ndash;36% of cases had unclear etiology[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe further demonstrate that utilization of parametric mapping has potential to decrease the number of cases with unclear etiology of SCA and hence influence clinical decision-making. Myocarditis, a common SCA cause, remains underdiagnosed[\u003cspan additionalcitationids=\"CR29 CR30 CR31 CR32\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Since endomyocardial biopsy is not recommended in every case of suspected myocarditis, CMR has become the gold standard non-invasive diagnostic method enabling tissue characterization of the entire myocardium[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35 CR36\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The diagnosis of myocardial inflammation is based on updated Lake Louis criteria including T1 and T2 mapping as well as late gadolinium enhancement imaging[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Combination of T2-weighted imaging with LGE imaging in studies on SCA survivors with inconclusive ischemic evaluation, resulted in diagnosing myocarditis in 6\u0026ndash;13% of cases[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Utilization of T2 mapping, that provides more accurate and quantitative assessment of myocardial edema, could potentially explain the higher percentage of myocarditis in our study (28%)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eT2 mapping contributed to a more certain diagnosis of other etiologies by either excluding myocarditis as a cause of SCA; confirming the diagnosis suspected based on ischemic evaluation and echocardiography as in takotsubo cardiomyopathy; or assessing the acuity and potential reversibility of the process as in MINOCA and ischemic cardiomyopathy[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These results have the potential to influence decisions regarding ICD implantation[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOther studies have also shown that T2 mapping is useful not only for making the diagnosis but also for risk stratification in certain diagnoses[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The degree of T2 elevation is a reliable predictor of major adverse cardiac events and heart failure hospitalization in patients with myocarditis[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. T2 elevation in hypertrophic cardiomyopathy can be used as a marker for arrhythmogenicity, and in dilated cardiomyopathy to identify patients with low probability of reverse remodeling [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eECV elevation, which was present in a significant subset of patients in our study, has been associated with adverse outcomes in various cardiomyopathy[\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. ECV in our population was highest in hypertrophic and ischemic CMP as well as MINOCA patients.\u003c/p\u003e \u003cp\u003eWe attempted to analyze the prognostic role of parametric mapping aware of the study limitations. Heterogeneity of included SCA etiologies is the most likely explanation of the lack of association between T1, T2, or ECV elevation and primary outcomes in our study. Our study was limited by a small sample size, which got even smaller as specific SCA etiologies were evaluated. Further studies that address specific etiologies of SCA, including our future expanded cohort, may be able to characterize association of parametric mapping abnormalities with outcome.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis is a single center small retrospective study. SCA etiologies were determined based on clinical data, and endomyocardial biopsy was not performed in most cases to confirm CMR-based diagnosis of myocarditis. The accuracy of the endomyocardial biopsy, however, is limited by sampling error due to the patchy nature of the inflammatory process[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince myocardial edema and inflammation observed on CMR could potentially be secondary to SCA (myocardial necrosis secondary to transient hypoxemia) or cardiopulmonary resuscitation, the data must be analyzed with caution and in correspondence with typical LGE pattern[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Since myocarditis in our study was diagnosed based on the updated Lake Louis criteria which includes T1 and T2 mapping and LGE, it is unlikely to affect results.\u003c/p\u003e \u003cp\u003eDistribution of SCA etiologies is not representative for the general population since only patients who survived SCA and had no clear cause of SCA were included in the study. Small sample size with very small subgroups of each SCA etiology limited analysis of the prognostic utility of parametric mapping.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTo conclude, inclusion of quantitative T1 and T2 parametric mapping in the SCA CMR protocol has the potential to increase diagnostic yield of CMR and further specify SCA etiology, especially myocarditis. CMR performed early after SCA may aid in the decision-making regarding ICD implantation. Further studies are needed to investigate the prognostic role of parametric mapping in SCA survivors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eDisclosures: N/A\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgments: N/A\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCarter-Monroe N, Virmani R (2011). Current Trends in the Classification of Sudden Cardiac Death Based on Autopsy Derived Data: A Review of Investigations Into the Etiology of Sudden Cardiac Death. Revista Espa\u0026ntilde;ola de Cardiolog\u0026iacute;a (English Edition) 64(1):10\u0026ndash;2. doi: 10.1016/j.recesp.2010.09.004. \u003c/li\u003e\n\u003cli\u003eZareba W, Zareba KM (2017). Cardiac Magnetic Resonance in Sudden Cardiac Arrest Survivors. Circ Cardiovasc Imaging. doi: 10.1161/CIRCIMAGING.117.007290. \u003c/li\u003e\n\u003cli\u003eZorzi A, Susana A, de Lazzari M, Migliore F, Vescovo G, Scarpa D, et al (2018). Diagnostic value and prognostic implications of early cardiac magnetic resonance in survivors of out-of-hospital cardiac arrest. Heart Rhythm 15(7):1031\u0026ndash;41. doi: 10.1016/j.hrthm.2018.02.033.\u003c/li\u003e\n\u003cli\u003eOjrzyńska-Witek N, Marczak M, Mazurkiewicz Ł, Petryka-Mazurkiewicz J, Miłosz-Wieczorek B, Grzybowski J, et al (2022). Sudden cardiac arrest: Focus on cardiac magnetic resonance. Kardiol Pol 80(1):87\u0026ndash;9. DOI: 10.33963/KP.a2021.0151.\u003c/li\u003e\n\u003cli\u003eZaremba T, Br\u0026oslash;ndberg AK, Jensen HK, Kim WY (2018). Cardiac magnetic resonance characteristics in young survivors of aborted sudden cardiac death. Eur J Radiol 105:141\u0026ndash;7. doi: 10.1016/j.ejrad.2018.06.004. \u003c/li\u003e\n\u003cli\u003eSwoboda P, Kidambi A, Uddin A, McDiarmid A, Ripley D, Greenwood J, et al (2014). Cardiovascular Magnetic Resonance is Valuable in the Investigation of Aborted Sudden Cardiac Death. Heart 100(Suppl 3):A71.2-A72. doi: 10.1136/heartjnl-2014-306118.125\u003c/li\u003e\n\u003cli\u003eRodrigues P, Joshi A, Williams H, Westwood M, Petersen SE, Zemrak F, et al (2017). Diagnosis and Prognosis in Sudden Cardiac Arrest Survivors Without Coronary Artery Disease: Utility of a Clinical Approach Using Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging Dec;10(12):e006709. doi: 10.1161/CIRCIMAGING.117.006709.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Brien AT, Gil KE, Varghese J, Simonetti OP, Zareba KM (2022). T2 mapping in myocardial disease: a comprehensive review. Journal of Cardiovascular Magnetic Resonance 24,33. doi: 10.1186/s12968-022-00866-0.\u003c/li\u003e\n\u003cli\u003eGiri S, Chung YC, Merchant A, Mihai G, Rajagopalan S, Raman S v., et al (2009). T2 quantification for improved detection of myocardial edema. Journal of Cardiovascular Magnetic Resonance 11(1):56. doi: 10.1186/1532-429X-11-56. \u003c/li\u003e\n\u003cli\u003eWong TC, Piehler KM, Kang IA, Kadakkal A, Kellman P, Schwartzman DS, et al (2014). Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J 35(10):657\u0026ndash;64. doi: 10.1093/eurheartj/eht193. \u003c/li\u003e\n\u003cli\u003eSchelbert EB, Piehler KM, Zareba KM, Moon JC, Ugander M, Messroghli DR, et al (2015). Myocardial fibrosis quantified by extracellular volume is associated with subsequent hospitalization for heart failure, death, or both across the spectrum of ejection fraction and heart failure stage. J Am Heart Assoc 4(12). doi: 10.1161/JAHA.115.002613. \u003c/li\u003e\n\u003cli\u003eCheng RK, Masri SC (2019). Extracellular Volume as an Imaging Biomarker for Incident Heart Failure. Circ Cardiovasc Imaging 12(12):10152. doi: 10.1161/CIRCIMAGING.119.010152.\u003c/li\u003e\n\u003cli\u003eSchelbert EB, Piehler KM, Zareba KM, Moon JC, Ugander M, Messroghli DR, et al (2015). Myocardial Fibrosis Quantified by Extracellular Volume Is Associated With Subsequent Hospitalization for Heart Failure, Death, or Both Across the Spectrum of Ejection Fraction and Heart Failure Stage. J Am Heart Assoc 4(12). doi: 10.1161/JAHA.115.002613. \u003c/li\u003e\n\u003cli\u003eLaohabut I, Songsangjinda T, Kaolawanich Y, Yindeengam A, Krittayaphong R (2021). Myocardial Extracellular Volume Fraction and T1 Mapping by Cardiac Magnetic Resonance Compared Between Patients With and Without Type 2 Diabetes, and the Effect of ECV and T2D on Cardiovascular Outcomes. Front Cardiovasc Med 7;0:1725. doi: 10.3389/fcvm.2021.771363. \u003c/li\u003e\n\u003cli\u003eYoun JC, Hong YJ, Lee HJ, Han K, Shim CY, Hong GR, et al (2017). Contrast-enhanced T1 mapping-based extracellular volume fraction independently predicts clinical outcome in patients with non-ischemic dilated cardiomyopathy: a prospective cohort study. Eur Radiol 27(9):3924\u0026ndash;33. doi: 10.1007/s00330-017-4817-9.\u003c/li\u003e\n\u003cli\u003eSchelbert EB, Fridman Y, Wong TC, Abu Daya H, Piehler KM, Kadakkal A, et al (2017). Temporal Relation Between Myocardial Fibrosis and Heart Failure With Preserved Ejection Fraction: Association With Baseline Disease Severity and Subsequent Outcome. JAMA Cardiol 2(9):995\u0026ndash;1006. doi: 10.1001/jamacardio.2017.2511. \u003c/li\u003e\n\u003cli\u003eKramer CM, Barkhausen J, Bucciarelli-Ducci C, Flamm SD, Kim RJ, Nagel E (2020). Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. Journal of Cardiovascular Magnetic 22(1):1\u0026ndash;18. https://doi.org/10.1186/s12968-020-00607-1.\u003c/li\u003e\n\u003cli\u003eHaaf P, Garg P, Messroghli DR, Broadbent DA, Greenwood JP, Plein S (2016). Cardiac T1 Mapping and Extracellular Volume (ECV) in clinical practice: A comprehensive review. Journal of Cardiovascular Magnetic Resonance 18(1):1\u0026ndash;12. doi: 10.1186/s12968-016-0308-4. \u003c/li\u003e\n\u003cli\u003eCerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al (2002). Standardized Myocardial Segmentation and Nomenclature for Tomographic Imaging of the Heart. Circulation 105(4):539\u0026ndash;42. doi: 10.1161/hc0402.102975.\u003c/li\u003e\n\u003cli\u003eAquaro GD, Perfetti M, Camastra G, Monti L, Dellegrottaglie S, Moro C, et al (2017). Cardiac MR With Late Gadolinium Enhancement in Acute Myocarditis With Preserved Systolic Function: ITAMY Study. J Am Coll 70(16):1977\u0026ndash;87. doi: 10.1016/j.jacc.2017.08.044. \u003c/li\u003e\n\u003cli\u003eMaron BJ, Maron MS (2016). LGE Means Better Selection of HCM Patients for Primary Prevention Implantable Defibrillators. JACC: Cardiovascular Imaging 9 (12) 1403\u0026ndash;1406.https://doi.org/10.1016/j.jcmg.2016.01.032.\u003c/li\u003e\n\u003cli\u003eBozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, et al (2016). Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement from the American Heart Association. Circulation 134:e579\u0026ndash;e646. https://doi.org/10.1161/CIR.0000000000000455.\u003c/li\u003e\n\u003cli\u003eMaron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al (2006). Contemporary definitions and classification of the cardiomyopathies: An American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 113(14):1807\u0026ndash;16. doi: 10.1161/CIRCULATIONAHA.106.174287.\u003c/li\u003e\n\u003cli\u003eSingh T, Khan H, Gamble DT, Scally C, Newby DE, Dawson D (2022). Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications. Circulation 145(13):1002\u0026ndash;19. doi: 10.1161/CIRCULATIONAHA.121.055854. \u003c/li\u003e\n\u003cli\u003eThavendiranathan P, Walls M, Giri S, Verhaert D, Rajagopalan S, Moore S, et al (2012). Improved detection of myocardial involvement in acute inflammatory cardiomyopathies using T2 mapping. Circ Cardiovasc Imaging 5(1):102\u0026ndash;10. doi: 10.1161/CIRCIMAGING.111.967836. \u003c/li\u003e\n\u003cli\u003eWu KC (2017). Sudden Cardiac Death Substrate Imaged by Magnetic Resonance Imaging: From Investigational Tool to Clinical Applications. Circ Cardiovasc Imaging 10(7):e005461. doi: 10.1161/CIRCIMAGING.116.005461.\u003c/li\u003e\n\u003cli\u003eBaritussio A, Zorzi A, Ghosh Dastidar A, Susana A, Mattesi G, Rodrigues JCL, et al (2017). Out of hospital cardiac arrest survivors with inconclusive coronary angiogram: Impact of cardiovascular magnetic resonance on clinical management and decision-making. Resuscitation 116:91\u0026ndash;7. doi: 10.1016/j.resuscitation.2017.03.039. \u003c/li\u003e\n\u003cli\u003eTsch\u0026ouml;pe C, Ammirati E, Bozkurt B, Caforio ALP, Cooper LT, Felix SB, et al (2021). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol 18(3):169-193. doi: 10.1038/s41569-020-00435-x.\u003c/li\u003e\n\u003cli\u003evon Knobelsdorff-Brenkenhoff F, Sch\u0026uuml;ler J, Dogang\u0026uuml;zel S, Dieringer MA, Rudolph A, Greiser A, et al (2017). Detection and Monitoring of Acute Myocarditis Applying Quantitative Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 10(2):1\u0026ndash;10. doi: 10.1161/CIRCIMAGING.116.005242.\u003c/li\u003e\n\u003cli\u003eGrun S, Schumm J, Greulich S, Wagner A, Schneider S, Bruder O, et al (2012). Long-term follow-up of biopsy-proven viral myocarditis: Predictors of mortality and incomplete recovery. J Am Coll Cardiol 59(18):1604\u0026ndash;15. doi: 10.1016/j.jacc.2012.01.007.\u003c/li\u003e\n\u003cli\u003eSpieker M, Katsianos E, Gastl M, Behm P, Horn P, Jacoby C, et al (2018). T2 mapping cardiovascular magnetic resonance identifies the presence of myocardial inflammation in patients with dilated cardiomyopathy as compared to endomyocardial biopsy. Eur Heart J Cardiovasc Imaging 19(5):574\u0026ndash;82. doi: 10.1093/ehjci/jex230. \u003c/li\u003e\n\u003cli\u003eL\u0026oslash;gstrup BB, Nielsen JM, Kim WY, Poulsen SH (20160. Myocardial oedema in acutemyocarditis detected by echocardiographic 2Dmyocardial deformation analysis. Eur Heart J Cardiovasc Imaging 17(9):1018\u0026ndash;26. doi: 10.1093/ehjci/jev302. \u003c/li\u003e\n\u003cli\u003eRuppert V, Meyer T, Pankuweit S, M\u0026ouml;ller E, Funck RC, Grimm W, et al (2008). Gene expression profiling from endomyocardial biopsy tissue allows distinction between subentities of dilated cardiomyopathy. Journal of Thoracic and Cardiovascular Surgery 136(2): 360-369.e1. doi: 10.1016/j.jtcvs.2008.03.016\u003c/li\u003e\n\u003cli\u003eAmmirati E, Frigerio M, Adler ED, Basso C, Birnie DH, Brambatti M, et al (2020). Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ Heart Fail 13(11):e007405. doi: 10.1161/CIRCHEARTFAILURE.120.007405.\u003c/li\u003e\n\u003cli\u003eSpieker M, Haberkorn S, Gastl M, Behm P, Katsianos S, Horn P, et al (2017). Abnormal T2 mapping cardiovascular magnetic resonance correlates with adverse clinical outcome in patients with suspected acute myocarditis. Journal of Cardiovascular Magnetic Resonance 19(1): 38. doi: 10.1186/s12968-017-0350-x. \u003c/li\u003e\n\u003cli\u003eP Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. 34(33):2636-48, 2648a-2648d. doi: 10.1093/eurheartj/eht210. \u003c/li\u003e\n\u003cli\u003eDass S, Suttie JJ, Piechnik SK, Ferreira VM, Holloway CJ, Banerjee R, et al (2012). Myocardial tissue characterization using magnetic resonance noncontrast T1 mapping in hypertrophic and dilated cardiomyopathy. Circ Cardiovasc Imaging 5(6):726\u0026ndash;33. doi: 10.1161/CIRCIMAGING.112.976738.\u003c/li\u003e\n\u003cli\u003eFerreira VM, Schulz-Menger J, Holmvang G, Kramer CM, Carbone I, Sechtem U, et al (2018). Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. J Am Coll Cardiol 72(24):3158\u0026ndash;76. doi: 10.1016/j.jacc.2018.09.072. \u003c/li\u003e\n\u003cli\u003eRodrigues P, Joshi A, Williams H, Westwood M, Petersen SE, Zemrak F, et al (2017). Diagnosis and Prognosis in Sudden Cardiac Arrest Survivors Without Coronary Artery Disease: Utility of a Clinical Approach Using Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 10(12):e006709. doi: 10.1161/CIRCIMAGING.117.006709. \u003c/li\u003e\n\u003cli\u003eBaig M, Galazka P, Dakwar O, Syed SA, Sawlani R, Shahir K, et al (2021). Prevalence of myocardial edema with T2 mapping in hypertrophic cardiomyopathy. J Am Coll Cardiol 77 (18_Supplement_1):1303.https://doi.org/10.1016/S0735-1097(21)02661-9\u003c/li\u003e\n\u003cli\u003eWong TC, Piehler KM, Kang IA, Kadakkal A, Kellman P, Schwartzman DS, et al (2014). Myocardial extracellular volume fraction quantified by cardiovascular magnetic resonance is increased in diabetes and associated with mortality and incident heart failure admission. Eur Heart J 35(10):657\u0026ndash;64. doi: 10.1093/eurheartj/eht193.\u003c/li\u003e\n\u003cli\u003eB\u0026ouml;nner F, Spieker M, Haberkorn S, Jacoby C, Fl\u0026ouml;gel U, Schnackenburg B, et al. Myocardial T2 Mapping Increases Noninvasive Diagnostic Accuracy for Biopsy-Proven Myocarditis. JACC: Cardiovascular Imaging 9:1467\u0026ndash;9. doi: 10.1016/j.jcmg.2015.11.014. \u003c/li\u003e\n\u003cli\u003eLurz P, Luecke C, Eitel I, F\u0026ouml;hrenbach F, Frank C, Grothoff M, et al (2016). Comprehensive Cardiac Magnetic Resonance Imaging in Patients with Suspected Myocarditis the MyoRacer-Trial. J Am Coll Cardiol 67(15):1800\u0026ndash;11. doi: 10.1016/j.jacc.2016.02.013.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline clinical and imaging characteristics of Sudden Cardiac Arrest Survivors.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations:\u0026nbsp;BSA - body surface area; SCA \u0026ndash; sudden cardiac arrest;\u0026nbsp;MINOCA - myocardial infarction with non-obstructive coronary arteries; CMR \u0026ndash; cardiovascular magnetic resonance; LVEDVI \u0026ndash; left ventricular end-diastolic volume index; LVESVI - left ventricular end-systolic volume index; LVEF \u0026ndash; left ventricular ejection fraction; LGE \u0026ndash; late gadolinium enhancement imaging; AHA \u0026ndash; American Heart Association.\u003c/p\u003e\n\u003cp\u003eContinuous variables are expressed as mean \u0026plusmn; standard deviation with normal distribution and median and interquartile range (25th-75th percentiles) with non-normal distribution. Categorical variables are presented as n (%).\u003c/p\u003e\n\u003cp\u003e*Calculated from the cohort having primary outcome data (all-cause mortality, heart transplant and arrhythmic outcomes)\u003c/p\u003e\n\u003ctable style=\"width: 5.2e+2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:157.25pt;border:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.4in;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eCharacteristic\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:1.25in;border:solid black 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:.4in;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eWhole cohort (n=35)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:2.5in;border:solid black 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:.4in;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003ePrimary Outcome*\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:94.5pt;border:solid black 1.0pt;border-left:none;padding:0in 5.4pt 0in 5.4pt;height:.4in;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:1.25in;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.4in;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eYes\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e(n=15)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.25in;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:.4in;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eNo\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e(n=17)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eAge, mean (SD), y\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e46.9\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026plusmn;\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e14.1\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e50.4 \u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003cspan style=\"font-size:13px;line-height:150%;color:black;\"\u003e\u0026plusmn; 15.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e46.1\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;line-height:150%;color:black;\"\u003e\u0026plusmn; 13.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.39\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eMale, No. (%)\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e20 (57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e9 (60.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e8 (47.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.46\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eBSA, mean (SD), m\u003csup\u003e2\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e2.1\u003c/span\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003e\u0026plusmn;0.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2.1\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;line-height:150%;color:black;\"\u003e\u0026plusmn; 0.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2.0\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;line-height:150%;color:black;\"\u003e\u0026plusmn; 0.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eObesity, No. (%)\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e13 (37)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e7 (46.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e5 (29.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eHypertension, No. (%)\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e24 (69)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e13 (86.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e10 (58.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eHyperlipidemia, No. (%)\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e14 (40)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e6 (40.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e6 (35.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eDiabetes mellitus, No. (%)\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e6 (17)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (13.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e3 (17.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eAtrial fibrillation, No. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e6 (17)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (13.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e4 (23.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.66\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eCoronary artery disease, No. (%)\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e16 (46)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eStroke, No. (%)\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e4 (11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (13.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (11.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eChronic kidney disease, No. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e4 (11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (13.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (11.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eChronic obstructive pulmonary disease, No.\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;\"\u003e(%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e2 (6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (13.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0 (0.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 521.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eSCA m\u003c/span\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eechanism, No. (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eVentricular fibrillation/ventricular tachycardia\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e33 (94)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e14 (93.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e16 (94.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003ePulseless electrical activity\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e2 (6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1 (6.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1 (5.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:-1.15pt;text-align:justify;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;color:black;\"\u003eSuspected SCA etiology, No. (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.65\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;line-height:150%;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eSuspected SCA etiology by CMR, No. (%)\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eMyocarditis (parametric mapping essential for the diagnosis)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e10 (29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e4 (27)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e5 (29)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eHypertrophic cardiomyopathy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e4 (11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1 (7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e3 (18)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eNon-ischemic cardiomyopathy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;'\u003e\u003cspan style=\"font-size:13px;\"\u003e5 (14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (13)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e3 (18)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eIschemic cardiomyopathy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e3 (9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e3 (20.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0 (0.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eTako-tsubo cardiomyopathy (parametric mapping essential for the diagnosis)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1 (3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0 (0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1 (6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cstrong\u003e\u003cem\u003e\u003cspan style=\"font-size:13px;\"\u003eSuspected SCA etiology based on other tests, No. (%)\u003c/span\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eIschemic cardiomyopathy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e3 (9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1 (7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1 (6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003ePrimarily electric etiology\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e5 (14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e3 (20)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (12)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eUnclear cause\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e4 (11)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1 (7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (12)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 521.75pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;line-height:150%;'\u003e\u003cstrong\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003eCMR parameters, mean (SD)\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLVEDVI, mean (SD), ml/m2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e87 (27)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e91 (23)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e85 (30)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLVESVI, mean (SD), ml/m2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e51 (25)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e55 (25)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e49 (27)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLVEF, mean (SD), %,\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e49 (13)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e46 (14)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e52 (13)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 17.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eT1 elevation, No. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;height: 17.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e18 (51%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;height: 17.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e10 (66.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;height: 17.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e7 (41.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;height: 17.5pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eMean T1, mean (SD), ms\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e1069 \u0026plusmn; 60\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1085 \u0026plusmn; 63\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1059 \u0026plusmn; 57\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eECV, mean (SD), %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e30 \u0026plusmn; 7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e30 \u0026plusmn; 7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e29 \u0026plusmn; 7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.69\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eT2 elevation, No. (%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e22 (63%)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e9 (60.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e11 (64.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eMean T2, mean (SD), ms\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e65 \u0026plusmn; 10\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e64 \u0026plusmn; 10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e65 \u0026plusmn; 11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.71\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLGE presence, No. (%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e32 (91)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e13 (86.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e16 (94.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.59\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLGE midwall, No. (%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e24 (69)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e8 (53.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e15 (88.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.03\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLGE subepicardial, No. (%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e7 (20)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (13.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e4 (23.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.66\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLGE subendocardial, No. (%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e7 (20)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e4 (26.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e2 (11.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eLGE transmural, No. (%)\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e4 (11.4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e3 (20.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e1 (5.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 157.25pt;border-right: 1pt solid black;border-bottom: 1pt solid black;border-left: 1pt solid black;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;margin-left:7.85pt;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003eAHA segments, median (IQR)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:justify;'\u003e\u003cspan style=\"font-size:13px;\"\u003e5 (4-8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e4 (3-7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.25in;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e5 (4-10)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94.5pt;border-top: none;border-left: none;border-bottom: 1pt solid black;border-right: 1pt solid black;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style='margin:0in;font-size:16px;font-family:\"Times New Roman\",serif;text-align:center;line-height:150%;'\u003e\u003cspan style=\"font-size:13px;line-height:150%;\"\u003e0.22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-international-journal-of-cardiovascular-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caim","sideBox":"Learn more about [The International Journal of Cardiovascular Imaging](https://www.springer.com/journal/10554)","snPcode":"10554","submissionUrl":"https://submission.nature.com/new-submission/10554/3","title":"The International Journal of Cardiovascular Imaging","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"sudden cardiac arrest, cardiovascular magnetic resonance imaging, parametric mapping, T1 and T2 mapping","lastPublishedDoi":"10.21203/rs.3.rs-2643647/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2643647/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eEtiology of sudden cardiac arrest (SCA) is identified in less than 30% of survivors without coronary artery disease. We sought to assess the diagnostic role of myocardial parametric mapping using cardiovascular magnetic resonance (CMR) in identifying SCA etiology.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eConsecutive SCA survivors undergoing CMR with myocardial parametric mapping were included in the study. The determination if CMR was decisive or contributory in identifying SCA etiology was made if the diagnosis was unclear prior to CMR, and the discharge diagnosis was consistent with the CMR result. Parametric mapping was considered essential for the CMR diagnosis if the SCA etiology could have not been determined without its utilization, and contributory if the diagnosis could have been potentially based on the combination of cine and LGE imaging, without optimal assessment of the severity and prognosis of the disease (offered by parametric mapping).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 35 patients (mean age 46.9\u0026thinsp;\u0026plusmn;\u0026thinsp;14.1 years; 57% males) included, diagnosis was based on CMR in 23 (66%) patients. Of those, parametric mapping was essential for the diagnosis of myocarditis and tako-tsubo cardiomyopathy (11/48%) and contributed to the diagnosis in 10 (43%) additional cases.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eInclusion of quantitative T1 and T2 parametric mapping in the SCA CMR protocol has the potential to increase diagnostic yield of CMR and further specify SCA etiology, especially myocarditis. CMR performed early after SCA may aid in the decision-making regarding ICD implantation.\u003c/p\u003e","manuscriptTitle":"The Role of T1 and T2 Mapping on Cardiovascular Magnetic Resonance Imaging in Sudden Cardiac Arrest Survivors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-07 15:17:25","doi":"10.21203/rs.3.rs-2643647/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-04-03T17:44:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-04-03T15:42:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-25T10:08:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"bb397a57-d73e-40c8-8b9a-68e61c28241d","date":"2023-03-19T02:50:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2252e1bc-5ec2-4954-a97a-c983e9c694b1","date":"2023-03-18T20:00:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-03-03T19:45:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-03-03T04:24:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-03-03T04:24:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"The International Journal of Cardiovascular Imaging","date":"2023-03-01T14:36:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-international-journal-of-cardiovascular-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caim","sideBox":"Learn more about [The International Journal of Cardiovascular Imaging](https://www.springer.com/journal/10554)","snPcode":"10554","submissionUrl":"https://submission.nature.com/new-submission/10554/3","title":"The International Journal of Cardiovascular Imaging","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0a93eddf-ff5d-4260-933e-696f1eb44a94","owner":[],"postedDate":"March 7th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T21:02:17+00:00","versionOfRecord":{"articleIdentity":"rs-2643647","link":"https://doi.org/10.1007/s10554-023-02864-4","journal":{"identity":"the-international-journal-of-cardiovascular-imaging","isVorOnly":false,"title":"The International Journal of Cardiovascular Imaging"},"publishedOn":"2023-05-05 20:41:43","publishedOnDateReadable":"May 5th, 2023"},"versionCreatedAt":"2023-03-07 15:17:25","video":"","vorDoi":"10.1007/s10554-023-02864-4","vorDoiUrl":"https://doi.org/10.1007/s10554-023-02864-4","workflowStages":[]},"version":"v1","identity":"rs-2643647","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2643647","identity":"rs-2643647","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}