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Diagnostic Impact and Prognostic Value of Cardiac Magnetic Resonance in Patients With Ventricular Arrhythmias
Yin Ge1, Panagiotis Antiochos2, Ayako Seno3
1Cardiovascular Imaging Program, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Insights
Cardiac magnetic resonance (CMR) improves diagnosis and risk prediction for patients with ventricular arrhythmias. This imaging technique offers valuable insights beyond standard care, aiding in the assessment of sudden cardiac death risk.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Cardiac magnetic resonance (CMR) is crucial for identifying myocardial substrates linked to sudden cardiac death (SCD).
- The clinical utility of CMR in patients with ventricular arrhythmias requires further definition.
Purpose of the Study:
- To evaluate the diagnostic and prognostic capabilities of multiparametric CMR.
- To assess its value in patients referred for ventricular arrhythmia evaluation.
Main Methods:
- A cohort of 642 patients with nonsustained ventricular tachycardia (NSVT) or sustained VT/SCD underwent CMR.
- Patients were followed for major adverse cardiac events (MACE), including death, recurrent arrhythmias, and heart failure hospitalization.
Main Results:
- Abnormal CMR findings were more prevalent in VT/SCD patients (66%) than NSVT patients (40%).
- Abnormal CMR was significantly associated with increased MACE in both NSVT and VT/SCD groups, even after adjusting for ejection fraction.
- CMR improved risk prediction models for MACE in the NSVT cohort.
Conclusions:
- Multiparametric CMR offers diagnostic clarification for ventricular arrhythmias.
- CMR provides effective risk stratification beyond standard care for these patients.
Background:
Cardiac magnetic resonance (CMR) characterizes myocardial substrate relevant to sudden cardiac death (SCD). However, its clinical value in patients presenting with ventricular arrhythmias is still being defined.
Objectives:
The authors sought to examine the diagnostic and prognostic value of multiparametric CMR in a cohort of consecutive patients referred for assessment of ventricular arrhythmias.
Methods:
Consecutive patients undergoing CMR for nonsustained ventricular tachycardia (NSVT) (n = 345) or sustained ventricular tachycardia (VT)/aborted SCD (n = 297) were followed over a median of 4.4 years. Major adverse cardiac events included death, recurrent VT/ventricular fibrillation requiring therapy, and hospitalization for congestive heart failure.
Results:
Of the 642 patients, 256 were women (40%), mean age was 54 ± 15 years, and median left ventricular ejection fraction was 58% (IQR: 49%-63%). A structurally abnormal heart by CMR assessment was detected in 40% of patients with NSVT and 66% in those with VT/SCD (P < 0.001). CMR assessment yielded a diagnostic change in 27% of NSVT patients vs 41% of those with VT/SCD (P < 0.001). During follow-up, 51 patients (15%) with NSVT and 104 patients (35%) with VT/SCD experienced major adverse cardiac events (MACE). An abnormal CMR was associated with a higher annual rate for MACE for both NSVT (0.7% vs 7.7%; P < 0.001) and VT/SCD (3.8% vs 13.3%; P < 0.001) patients. In a multivariate model including left ventricular ejection fraction, an abnormal CMR remained strongly associated with MACE in NSVT (HR: 5.23 [95% CI: 2.28-12.0]; P < 0.001) and VT/SCD (HR: 1.88 [95% CI: 1.07-3.30]; P = 0.03). Adding CMR assessment to the multivariable model for MACE yielded a significant improvement in the integrated discrimination improvement and an improvement in the C-statistic in the NSVT cohort.
Conclusions:
In patients presenting with ventricular arrhythmias, multiparametric CMR assessment provides diagnostic clarification and effective risk stratification beyond current standard of care.
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