Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias

Nikolaidou, Chrysovalantou; Kotanidis, Christos; Wijesurendra, Rohan S.; Leal-Pelado, J; Κούσκουρας, Κωνσταντίνος; Vassilikos, Vassilios; Karvounis, Haralambos; Ntusi, Ntobeko; Antoniades, Charalambos; Neubauer, Stefan; Karamitsos, Theodoros D.

doi:10.3390/diagnostics11061109

Cited by 7 publications

(5 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Four patients showed signs of fibrosis, but none was of ischemic origin (previous myocardial infarction) based on LGE pattern, localization and distribution. In a recently published study [36] the authors established an underlying diagnosis in about 30% of the unrolled patients, despite a normal echocardiogram, with an additional 20% of the patients showing more subtle signs of pathology.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings

et al. 2021

View full text Add to dashboard Cite

The prognosis of patients with ventricular ectopy and a normal heart, as evaluated by echocardiography, is virtually unknown. Cardiac magnetic resonance (CMR) can detect focal ventricular anomalies that could act as a possible site of origin for premature ventricular contractions (PVCs). The aim of this study was to investigate the presence of cardiac anomalies in patients with normal findings at echocardiogram. Methods: Fifty-one consecutive patients (23 women, 28 men, mean age 59 years) with very high PVC burden (>10,000 PVC/day) and normal findings at standard echocardiography and exercise test were examined with CMR. The outcome was pathologic findings, defined as impaired ejection fraction, regional wall motion abnormalities, abnormal ventricular volume, myocardial edema and fibrosis. Results: Sixteen out of 51 patients (32%) had structural ventricular abnormalities at CMR. In five patients CMR showed impairment of the left ventricular and/or right ventricular systolic function, and six patients had a dilated left and/or right ventricle. Regional wall motion abnormalities were seen in six patients and fibrosis in four. No patient had CMR signs of edema or met CMR criteria for arrhythmogenic right ventricular cardiomyopathy. Five patients had extra-ventricular findings (enlarged atria in three cases, enlarged thoracic aorta in one case and pericardial effusion in one case). Conclusions: In this study 16 out of 51 patients with a high PVC burden and normal findings at echocardiography showed signs of pathology in the ventricles with CMR. These findings indicate that CMR should be considered in evaluating patients with a high PVC burden and a normal standard investigation.

show abstract

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Different autopsy series report highly variable prevalence of myocarditis, ranging from 2% to 42% in young people with SCD [ 65 ]. Importantly, undiagnosed previous or chronic myocarditis can present as unexplained PVCs in otherwise healthy individuals [ 66 ]. CMR can identify active or previous myocarditis in patients with unexplained VAs by demonstrating acute myocardial eodema on T2-weighted imaging, hyperaemia on early gadolinium imaging, and/or scar on LGE, as described in the Lake Louise criteria for the non-invasive diagnosis of myocarditis [ 67 ].…”

Section: Determining the Underlying Etiology Of Arrhythmiamentioning

confidence: 99%

“…Conversely, CMR with tissue characterisation can detect underlying substrate concealed on conventional investigations in a significant proportion of patients with idiopathic VAs, such as PVCs, which varies from 13.7% to 78.8% according to the study population. Additionally, myocardial strain evaluated with CMR is more sensitive than LVEF in detecting incipient contractile dysfunction in patients with frequent idiopathic VAs and PVC-related or other types of underlying cardiomyopathy, and can thus guide early treatment [ 66 ]. Importantly, myocardial structural abnormalities detected on CMR can redefine patient prognosis and improve risk stratification, as they are associated with worse clinical outcomes, such as nonfatal episodes of ventricular fibrillation or sustained VT, resuscitated cardiac arrest, or SCD [ 89 , 90 ].…”

Section: Determining the Underlying Etiology Of Arrhythmiamentioning

confidence: 99%

The Role of Cardiovascular Magnetic Resonance Imaging in Patients with Cardiac Arrhythmias

Nikolaidou,

Ormerod,

Ziakas

et al. 2023

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

Cardiac arrhythmias are associated with significant morbidity, mortality and poor quality of life. Cardiovascular magnetic resonance (CMR) imaging, with its unsurpassed capability of non-invasive tissue characterisation, high accuracy, and reproducibility of measurements, plays an integral role in determining the underlying aetiology of cardiac arrhytmias. CMR can reliably diagnose previous myocardial infarction, non-ischemic cardiomyopathy, characterise congenital heart disease and valvular pathologies, and also detect the underlying substrate concealed on conventional investigations in a significant proportion of patients with arrhythmias. Determining the underlying substrate of arrhythmia is of paramount importance for treatment planning and prognosis. However, CMR imaging in patients with irregular heart rates can be problematic. Understanding the different ways to overcome the limitations of CMR in arrhythmia is essential for providing high-quality imaging, comprehensive information, and definitive answers in this diverse group of patients.

show abstract

“…Given the constraints of LVEF and the varying pathophysiological mechanisms that may promote the development of VAs, several studies have evaluated the potential prognostic utility of other biomarkers in the context of VAs. These include electrocardiographic markers as well as findings from cardiac magnetic resonance imaging, computed tomography, radionuclide imaging, and novel echocardiographic techniques [8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Strain Imaging and Ventricular Arrhythmia

et al. 2023

View full text Add to dashboard Cite

Ventricular arrhythmia is one of the main causes of sudden cardiac death. Hence, identifying patients at risk of ventricular arrhythmias and sudden cardiac death is important but can be challenging. The indication for an implantable cardioverter defibrillator as a primary preventive strategy relies on the left ventricular ejection fraction as a measure of systolic function. However, ejection fraction is flawed by technical constraints and is an indirect measure of systolic function. There has, therefore, been an incentive to identify other markers to optimize the risk prediction of malignant arrhythmias to select proper candidates who could benefit from an implantable cardioverter defibrillator. Speckle-tracking echocardiography allows for a detailed assessment of cardiac mechanics, and strain imaging has repeatedly been shown to be a sensitive technique to identify systolic dysfunction unrecognized by ejection fraction. Several strain measures, including global longitudinal strain, regional strain, and mechanical dispersion, have consequently been proposed as potential markers of ventricular arrhythmias. In this review, we will provide an overview of the potential use of different strain measures in the context of ventricular arrhythmias.

show abstract

Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias

Cited by 7 publications

References 44 publications

Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings

Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings

The Role of Cardiovascular Magnetic Resonance Imaging in Patients with Cardiac Arrhythmias

Strain Imaging and Ventricular Arrhythmia

Contact Info

Product

Resources

About