This is a 30-years old man with sustained tachycardia. All other investigations were normal and he came for a cardiac MRI. The contrast-enhanced CMR study shows a mid-myocardial area of enhancement in the mid antero-septal region with ill-defined epicardial and septal enhancement as well. Eventually, this area correlated with the abnormal focus on electrophysiologic studies and the patient was put on an ICD.
The usefulness of CMR in picking up the anatomic substrate for inducible ischemia in patients with nonischemic cardiomyopathy is known. This has now been further elaborated upon by Nazarian et al from Johns Hopkins in this week's issue of Circulation. We have also briefly discussed this in our accompanying literature blog. In brief, they have shown that scar involving 26-75% of the myocardium is predictive of inducible tachycardia and can identify high-risk individuals.