Summary of patients’ characteristics, complications, and clinical impact of stress CMR in published articles.

Summary of patients’ characteristics, complications, and clinical impact of stress CMR in published articles.</p

Flow diagram of the study.

Abbreviations: CAD = coronary artery disease, CMR = cardiac magnetic resonance.</p

Hemodynamic parameters at rest and during adenosine infusion.

Abbreviations: DBP = diastolic blood pressure, HR = heart rate, SBP = systolic blood pressure.</p

Clinical characteristics of the study population.

BackgroundAdenosine stress cardiac magnetic resonance (CMR) imaging is increasingly utilized for evaluating patients with known or suspected coronary artery disease (CAD). This study aims to assess the safety and clinical impact of adenosine stress CMR in a tertiary care setting in Thailand.MethodsA total of 3,768 consecutive patients aged 18 years and above who underwent adenosine stress CMR between 2017 and 2020 were included in the study. Patient records were reviewed to collect data on clinical characteristics, hemodynamic measurements, complications during or immediately after CMR, and the rates of clinical changes resulting from CMR.ResultsAmong the included patients, the primary indications for adenosine stress CMR were risk stratification in suspected CAD (70.8%) and the assessment of myocardial ischemia/viability in patients with known CAD (26.5%). There were no reported deaths or acute myocardial infarctions during the procedure. Major complications, specifically acute pulmonary edema requiring hospital observation or admission for further management, occurred in four patients (0.11%), all of whom were elderly (ranging from 75 to 91 years) with a history of heart failure. Non-major complications were observed in 13.7% of patients, with dyspnea (9.8%) and mild chest pain (5.6%) being the most common. CMR provided a completely new diagnosis in 26.2% of patients. Overall, stress CMR resulted in a change in diagnosis or management for 48% of patients.ConclusionAdenosine stress CMR was found to be safe and to have a significant impact on clinical management in Asian patients with known or suspected CAD. These findings support the use of adenosine stress CMR as a valuable tool for evaluating and guiding treatment decisions in this patient population.</div

Non-major complications during or immediately after CMR scans.

Non-major complications during or immediately after CMR scans.</p

Major complications during or immediately after CMR scans.

Major complications during or immediately after CMR scans.</p

Impact of CMR on diagnosis and patient management.

Impact of CMR on diagnosis and patient management.</p

Characteristics of sudden unexpected death syndrome (SUDS) patients.

<p>Characteristics of sudden unexpected death syndrome (SUDS) patients.</p

Molecular investigation by whole exome sequencing revealed a high proportion of pathogenic variants among Thai victims of sudden unexpected death syndrome

<div><p>Introduction</p><p>Sudden unexpected death syndrome (SUDS) is an important cause of death in young healthy adults with a high incident rate in Southeast Asia; however, there are no molecular autopsy reports about these victims. We performed a combination of both a detailed autopsy and a molecular autopsy by whole exome sequencing (WES) to investigate the cause of SUDS in Thai sudden death victims.</p><p>Materials and methods</p><p>A detailed forensic autopsy was performed to identify the cause of death, followed by a molecular autopsy, in 42 sudden death victims who died between January 2015 and August 2015. The coding sequences of 98 SUDS-related genes were sequenced using WES. Potentially causative variants were filtered based on the variant functions annotated in the dbNSFP database. Variants with inconclusive clinical significance evidence in ClinVar were resolved with a variant prediction algorithm, metaSVM, and the frequency data of the variants found in public databases, such as the 1000 Genome Project, ESP6500 project, and the Exome Aggregation Consortium (ExAc) project.</p><p>Results</p><p>Combining both autopsy and molecular autopsy enabled the potential identification of cause of death in 81% of the cases. Among the 25 victims with WES data, 72% (18/25) were found to have potentially causative SUDS mutations. The majority of the victims had at a mutation in the <i>TTN</i> gene (8/18 = 44%), and only one victim had an <i>SCN5A</i> mutation.</p><p>Conclusions</p><p>WES can help to identify the genetic causes in victims of SUDS and may help to further guide investigations into their relatives to prevent additional SUDS victims.</p></div

Characteristics of each patient.

<p>Characteristics of each patient.</p