Cardiac MRI structural and functional predictors of left ventricular ejection fraction recovery following PVC catheter ablation

Abstract

Frequent premature ventricular contractions (PVCs) can induce cardiomyopathy (PVC CM). We sought to use cardiac magnetic resonance imaging (CMR) to quantify changes in cardiac structure and function of cardiomyopathy patients following catheter ablation for PVCs. Patients undergoing PVC ablation at the Johns Hopkins Hospital with pre-procedural CMR from 2010 to 2018 were included in this study. CMR Images were analyzed to collect information on cardiac structure and function as well as to quantify scar. Of the total 51 included patients, PVC CM (LVEF < 45%) was observed in 51% (n = 29). Of these, 19 had post-ablation ejection fractions quantified, with 78.9% (n = 15) recovering function. Global longitudinal strain was significantly correlated with LVEF (OR 1.831, p < 0.01) but did not predict recovery of function. RV origin of PVCs was more common in the preserved LVEF group but was also significantly correlated with persistently reduced EF post-ablation in the PVC CM group. Scar burden was not correlated with either cardiac function or post-ablation recovery of function. In this cohort, there were no significant CMR findings to predict subsequent recovery of EF after ablation among those with PVC CM. PVC origin in the RV was associated with persistently reduced LVEF after ablation.

Premature Ventricular Contraction-Induced Cardiomyopathy: Contemporary Evidence from Risk Stratification, Pathophysiology, and Management

“…Studies have found that a higher frequency of PVCs correlates to the severity of LV dysfunction [11,12,45]. However, it is important to note that cases with frequent PVCs do not necessarily have cardiomyopathy and it is thought that the duration of having PVC might also correlate to the development of PIC [11,44,46,47], making a clear cutpoint that assures the development of cardiomyopathy hard to estimate. Some authors have suggested 10,000-20,000 PVCs/day or PVCs > 10% of total beats as a high PVC burden [42].…”

“…A study found that PVCs with RV origins are statistically correlated to persistently reduced EF even after ablation [47]. However, other studies showed only epicardial origins are correlated with the development of PIC and are associated with the highest risk of cardiomyopathy [30].…”

“…Echocardiogram findings that have been seen in PIC are mild to moderate decreased LVEF, increased LV systolic and diastolic dimensions, global wall motion abnormalities, and mitral regurgitation [42,44]. A global longitudinal strain is shown to be a significant mortality predictor [47].…”

“…The morphology and extent of LGE help differentiate non-ischemic fibrosis from scarring related to myocardial infarction and can be used to detect subclinical atherosclerosis in asymptomatic patients [51]. Most patients with ischemic cardiomyopathy have significant scars compared to PIC patients who have none or minimal scarring in a non-ischemic pattern that could help confirm PVC origins [44,47].…”

Mechanisms and Risk Factors for Premature Ventricular Contraction Induced Cardiomyopathy

“…GLS appears to be useful to predict changes in LV function. Additionally, GLS is considered a prognostic indicator in PVICM, based on the association between mortality and GLS levels in cardiomyopathy patients [ 78 ].…”