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Predictors of Myocardial Fibrosis Detected by CMR in Patients With Idiopathic PVCs
Ștefan Ailoaei1,2, Laurențiu Șorodoc2,3, Carina Ureche1,2
1Department of Cardiology, Institute for Cardiovascular Diseases "Prof. Dr. George I. M. Georgescu", Iași, Romania.
Background:
Premature ventricular contractions (PVCs) are a frequent electrocardiographic finding in routine medical practice, and 16% of the patients with idiopathic PVCs may have underlying heart disease.
Objective:
We analyzed the correlation between the morphology of the PVCs and the myocardial scarring identified by cardiac magnetic resonance (CMR), together with the impact of late gadolinium enhancement (LGE) on the need for ablation.
Methods:
Ninety-four patients (median age 56 years) with frequent PVCs (> 500 PVCs on 24 h) and a structurally normal heart were referred for comprehensive CMR. The patients were followed for 12 months. Patients were referred for ablation if they were symptomatic in the context of frequent PVCs.
Results:
The prevalence of LGE identified by CMR was higher among males (OR 5.506 (2.092-14.49) p < 0.05), with an age ≥ 50 years (OR 1.047 (1.015-1.08), p < 0.05) and a higher PVC burden (OR 1.922 (1.723-1.976), p < 0.05). Additionally, patients with PVCs with a LBBB inferior axis had four times higher risk of exhibiting LGE (OR 4.09 (1.584-10.565), p < 0.05). In multivariate analysis, age (OR 1.059 (1.019-1.099), p < 0.05) and a LBBB inferior axis (OR 4.605 (1.472-14.404), p < 0.05) were independently associated with the presence of LGE.
Conclusion:
Patients with PVCs and apparently, structurally normal heart present myocardial scarring identified by CMR in 71.23% of cases. PVCs with LBBB inferior axis pattern, age ≥ 50 years and male sex are associated with the presence of LGE on CMR. In multivariate analysis, age and LBBB inferior axis were independently correlated with the presence of LGE.
Insights
Premature ventricular contractions (PVCs) often indicate underlying heart disease, even in structurally normal hearts. Cardiac MRI reveals myocardial scarring in 71% of patients, linked to PVC morphology, age, and sex.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Premature ventricular contractions (PVCs) are common electrocardiographic findings.
- A significant percentage of patients with idiopathic PVCs may have underlying heart disease, necessitating further investigation.
Purpose of the Study:
- To investigate the correlation between PVC morphology and myocardial scarring detected by cardiac magnetic resonance (CMR).
- To assess the impact of late gadolinium enhancement (LGE) on the need for ablation in patients with PVCs.
Main Methods:
- Ninety-four patients with frequent PVCs and structurally normal hearts underwent comprehensive CMR.
- Patients were monitored for 12 months, with ablation referral for symptomatic individuals.
Main Results:
- Late gadolinium enhancement (LGE) was identified in 71.23% of patients.
- Prevalence of LGE was higher in males, individuals aged ≥50 years, and those with higher PVC burden.
- PVCs with a Left Bundle Branch Block (LBBB) inferior axis pattern showed a fourfold increased risk of LGE.
Conclusions:
- Myocardial scarring is prevalent in patients with PVCs, even with apparently normal heart structure.
- Age (≥50 years) and LBBB inferior axis pattern are independent predictors of LGE on CMR.
- These findings highlight the importance of CMR in evaluating patients with frequent PVCs.
