Daniele Muser1, Pasquale Santangeli2, Simon A Castro2, Ruben Casado Arroyo3, Shingo Maeda4, Daniel A Benhayon5, Ioan Liuba6, Jackson J Liang2, Mouhannad M Sadek7, Anwar Chahal2, Silvia Magnani8, Maurizio Pieroni9, Elena Santarossa10, Benoit Desjardins11, Sanjay Dixit2, Fermin C Garcia2, David J Callans2, David S Frankel2, Abass Alavi11, Francis E Marchlinski2, Joseph B Selvanayagam12, Gaetano Nucifora13. 1. Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy. 2. Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 3. Cardiology Department, Université Libre de Bruxelles, Brussels, Belgium. 4. Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan. 5. Cardiac Electrophysiology, Memorial Healthcare System, Hollywood, Florida, USA. 6. Division of Electrophysiology, Department of Cardiology, University Hospital Linköping, Linköping, Sweden. 7. Cardiac Electrophysiology, University of Ottawa Heart Institute, Ottawa, Canada. 8. Cardiac Electrophysiology/Heart Rhythm Center, New York University, New York, New York, USA. 9. Cardiovascular Department, San Donato Hospital, Arezzo, Italy. 10. Cardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy. 11. Radiology Department, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 12. Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia. 13. Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia; Cardiac Imaging Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom. Electronic address: gaetano.nucifora@mft.nhs.uk.
Abstract
OBJECTIVES: This study investigated the prevalence and prognostic significance of concealed myocardial abnormalities identified by cardiac magnetic resonance (CMR) imaging in patients with apparently idiopathic premature ventricular contractions (PVCs). BACKGROUND: The role of CMR imaging in patients with frequent PVCs and otherwise negative diagnostic workup is uncertain. METHODS: This was a multicenter, international study that included 518 patients (age 44 ± 15 years; 57% men) with frequent (>1,000/24 h) PVCs and negative routine diagnostic workup. Patients underwent a comprehensive CMR protocol including late gadolinium enhancement imaging for detection of necrosis and/or fibrosis. The study endpoint was a composite of sudden cardiac death, resuscitated cardiac arrest, and nonfatal episodes of ventricular fibrillation or sustained ventricular tachycardia that required appropriate implantable cardioverter-defibrillator therapy. RESULTS: Myocardial abnormalities were found in 85 (16%) patients. Male gender (odds ratio [OR]: 4.28; 95% confidence interval [CI]: 2.06 to 8.93; p = 0.01), family history of sudden cardiac death and/or cardiomyopathy (OR: 3.61; 95% CI: 1.33 to 9.82; p = 0.01), multifocal PVCs (OR: 11.12; 95% CI: 4.35 to 28.46; p < 0.01), and non-left bundle branch block inferior axis morphology (OR: 14.11; 95% CI: 7.35 to 27.07; p < 0.01) were all significantly related to the presence of myocardial abnormalities. After a median follow-up of 67 months, the composite endpoint occurred in 26 (5%) patients. Subjects with myocardial abnormalities on CMR had a higher incidence of the composite outcome (n = 25; 29%) compared with those without abnormalities (n = 1; 0.2%; p < 0.01). CONCLUSIONS: CMR can identify concealed myocardial abnormalities in 16% of patients with apparently idiopathic frequent PVCs. Presence of myocardial abnormalities on CMR predict worse clinical outcomes.
OBJECTIVES: This study investigated the prevalence and prognostic significance of concealed myocardial abnormalities identified by cardiac magnetic resonance (CMR) imaging in patients with apparently idiopathic premature ventricular contractions (PVCs). BACKGROUND: The role of CMR imaging in patients with frequent PVCs and otherwise negative diagnostic workup is uncertain. METHODS: This was a multicenter, international study that included 518 patients (age 44 ± 15 years; 57% men) with frequent (>1,000/24 h) PVCs and negative routine diagnostic workup. Patients underwent a comprehensive CMR protocol including late gadolinium enhancement imaging for detection of necrosis and/or fibrosis. The study endpoint was a composite of sudden cardiac death, resuscitated cardiac arrest, and nonfatal episodes of ventricular fibrillation or sustained ventricular tachycardia that required appropriate implantable cardioverter-defibrillator therapy. RESULTS:Myocardial abnormalities were found in 85 (16%) patients. Male gender (odds ratio [OR]: 4.28; 95% confidence interval [CI]: 2.06 to 8.93; p = 0.01), family history of sudden cardiac death and/or cardiomyopathy (OR: 3.61; 95% CI: 1.33 to 9.82; p = 0.01), multifocal PVCs (OR: 11.12; 95% CI: 4.35 to 28.46; p < 0.01), and non-left bundle branch block inferior axis morphology (OR: 14.11; 95% CI: 7.35 to 27.07; p < 0.01) were all significantly related to the presence of myocardial abnormalities. After a median follow-up of 67 months, the composite endpoint occurred in 26 (5%) patients. Subjects with myocardial abnormalities on CMR had a higher incidence of the composite outcome (n = 25; 29%) compared with those without abnormalities (n = 1; 0.2%; p < 0.01). CONCLUSIONS: CMR can identify concealed myocardial abnormalities in 16% of patients with apparently idiopathic frequent PVCs. Presence of myocardial abnormalities on CMR predict worse clinical outcomes.
Authors: J Lukas Laws; Megan C Lancaster; M Ben Shoemaker; William G Stevenson; Rebecca R Hung; Quinn Wells; D Marshall Brinkley; Sean Hughes; Katherine Anderson; Dan Roden; Lynne W Stevenson Journal: Circ Res Date: 2022-05-26 Impact factor: 23.213
Authors: Giovanni Volpato; Umberto Falanga; Laura Cipolletta; Manuel Antonio Conti; Gino Grifoni; Giuseppe Ciliberti; Alessia Urbinati; Alessandro Barbarossa; Giulia Stronati; Marco Fogante; Marco Bergonti; Valentina Catto; Federico Guerra; Andrea Giovagnoni; Antonio Dello Russo; Michela Casella; Paolo Compagnucci Journal: Medicina (Kaunas) Date: 2021-03-25 Impact factor: 2.430