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Published on: January 8, 2013
CMR for Identifying the Substrate of Ventricular Arrhythmia in Patients With Normal Echocardiography
Daniele Andreini1, Antonio Dello Russo2, Gianluca Pontone2
1Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
Insights
Cardiac MRI (CMR) effectively identifies structural heart disease (SHD) in patients with ventricular arrhythmia (VA) when echocardiography shows normal findings. Chest pain and sustained ventricular tachycardia predict positive CMR results.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Medicine
Background:
- Malignant ventricular arrhythmias (VA) account for half of sudden cardiac deaths.
- Echocardiography is the standard for identifying structural heart disease (SHD), the primary cause of VA.
- Many VA patients with normal echocardiograms may still have underlying SHD.
Purpose of the Study:
- To evaluate the utility of cardiac magnetic resonance (CMR) in detecting structural heart disease (SHD) in patients with ventricular arrhythmia (VA).
- To assess if CMR can identify SHD in patients whose echocardiography yielded no pathological findings.
- To identify predictors of positive CMR findings in this patient cohort.
Main Methods:
- A prospective, single-center study enrolled 946 patients with significant VA and normal echocardiograms.
- Patients underwent clinically indicated cardiac magnetic resonance (CMR) imaging.
- Primary endpoint was CMR detection of SHD; secondary endpoints included abnormal, non-specific findings.
Main Results:
- Cardiac magnetic resonance (CMR) diagnosed structural heart disease (SHD) in 25.5% (241/946) of patients.
- Myocarditis, arrhythmogenic cardiomyopathy, and dilated cardiomyopathy were the most common SHDs found.
- Chest pain and sustained ventricular tachycardia were the strongest predictors of SHD on CMR (ORs > 2.2).
Conclusions:
- Cardiac magnetic resonance (CMR) is valuable for diagnosing structural heart disease (SHD) in patients with ventricular arrhythmia (VA) and normal echocardiograms.
- CMR identified SHD in a significant proportion of patients previously presumed to have no cardiac pathology.
- Chest pain and sustained ventricular tachycardia are key indicators for considering CMR in VA patients.
Objectives:
This study sought to determine whether cardiac magnetic resonance (CMR) may identify structural heart disease (SHD) in patients with ventricular arrhythmia who had echocardiography ruled out pathological findings.
Background:
Approximately one-half of sudden cardiac deaths are attributable to malignant VA. Echocardiography is commonly used to identify SHD that is the most frequent substrate of VA.
Methods:
A single-center prospective study was conducted in consecutive patients with significant VA, categorized as >1,000 but <10,000 ventricular ectopic beats [VEBs]/24 h; ≥10,000 VEBs/24 h; nonsustained ventricular tachycardia, sustained ventricular tachycardia, or a history of resuscitated cardiac arrest, and no pathological findings at echocardiography, requiring a clinically indicated CMR. Primary endpoint was CMR detection of SHD. Secondary endpoints were a composite of CMR detection of SHD and abnormal findings not specific for a definite SHD diagnosis.
Results:
A total of 946 patients were enrolled (mean 41 ± 16 years of age; 64% men). CMR studies were used to diagnose SHD in 241 patients (25.5%) and abnormal findings not specific for a definite SHD diagnosis in 187 patients (19.7%). Myocarditis (n = 91) was the more frequent disease, followed by arrhythmogenic cardiomyopathy (n = 55), dilated cardiomyopathy (n = 39), ischemic heart disease (n = 22), hypertrophic cardiomyopathy (n = 13), congenital cardiac disease (n = 10), left ventricle noncompaction (n = 5), and pericarditis (n = 5). The strongest univariate and multivariate predictors of SHD on CMR images were chest pain (odds ratios [OR]: 2.52 and 2.38, respectively) and sustained ventricular tachycardia (ORs: 2.67 and 2.23, respectively).
Conclusions:
SHD was able to be identified on CMR imaging in a sizable number of patients with significant VA and completely normal echocardiography. Chest pain and sustained ventricular tachycardia were the strongest predictors of positive CMR imaging results.
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