Evidence for non-ischemic scarring in patients with ventricular ectopy

Jeserich, Michael; Friedrich, Matthias G.; Olschewski, Manfred; Kirchberger, Joachim; Kimmel, Simone; Bode, Christoph; Geibel, Annette

doi:10.1016/j.ijcard.2011.01.055

Cited by 9 publications

(11 citation statements)

References 24 publications

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“…Ten (22%) patients had ≥1 foci of LGE with subepicardial or midmyocardial distribution, possibly related to remote inflammatory tissue injury or underlying nonischemic structural heart disease. 22 One patient had regional signal abnormalities on T2-weighted imaging and regionally matched LGE with nonischemic pattern (findings consistent with acute myocarditis). Finally, 7 patients had signal alterations indicating both myocardial fatty replacement and nonischemic scarring of the LV, mainly involving the inferior and lateral wall; in 1 patient, signal alterations on T1-weighted and LGE imaging involving the RV were also observed.…”

Section: Discussionmentioning

confidence: 82%

“…20,21 Previous studies have investigated the clinical value of cine and T1-weighted cMRI among patients with apparently idiopathic VAs of RV origin [5][6][7][8][9][10][11][12][13][14] ; some authors demonstrated cMRI signal alterations in this group of patients, 5-8 whereas others showed RV wall motion abnormalities without signal alterations [9][10][11] or even any kind of RV abnormalities. [12][13][14] More recently, Jeserich et al 22 and Mavrogeni et al 23 evaluated the value of a cMRI protocol including T2-weighted and LGE imaging in patients with unexplained VAs (frequent PVBs and ventricular tachycardia, respectively); in both studies, LV myocardial structural abnormalities (including nonischemic scarring) were observed in the majority of patients. White et al 4 applied a cMRI protocol with comprehensive tissue characterization (including T1-weighted, T2-weighted, and LGE imaging) in 40 patients with resuscitated SCD or SVT and no abnormal findings on routine diagnostic work-up; half of these patients were diagnosed as having relevant myocardial disease.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Prognostic Value of Concealed Structural Abnormalities in Patients With Apparently Idiopathic Ventricular Arrhythmias of Left Versus Right Ventricular Origin

Nucifora

Muser

Masci

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Routine diagnostic work-up occasionally does not identify any abnormality among patients with monomorphic ventricular arrhythmias (VAs) of left ventricular (LV) origin. Aim of this study was to investigate the value of cardiac MRI (cMRI) for the diagnostic work-up and prognostication of these patients. Methods and Results-Forty-six consecutive patients (65% males; mean age, 44±15 years) with monomorphic VAs of LV origin and negative routine diagnostic work-up were included. Seventy-four consecutive patients (60% males; mean age, 40±17 years) with apparently idiopathic monomorphic VAs of right ventricular origin served as control group. Both groups underwent comprehensive cMRI study and were followed-up for a median of 14 months (25th-75th percentiles, 7-37 months). The outcome event was an arrhythmic composite end point of sudden cardiac death or nonfatal episode of ventricular fibrillation or sustained ventricular tachycardia requiring external cardioversion or appropriate implantable cardioverter defibrillator therapy. The 2 groups of patients did not differ in age (P=0.14) and sex (P=0.57). No significant difference was observed between patients with VAs of LV origin and VAs of right ventricular origin about biventricular volumes and systolic function. cMRI demonstrated myocardial structural abnormalities in 19 (41%) patients with VAs of LV origin versus 4 (5%) patients with VAs of right ventricular origin (P<0.001). The outcome event occurred in 9 patients; myocardial structural abnormalities on cMRI were significantly related to the outcome event (hazard ratio, 41.6; 95% confidence interval, 5.2-225.0; P<0.001). identification of concealed cardiac abnormalities in patients with apparently idiopathic LV arrhythmias. Moreover, scarce data are available about the prognostic value of concealed structural abnormalities detected by cMRI in these patients. Accordingly, the aim of this study was 2-fold: (1) to investigate the value of comprehensive cardiac magnetic resonance tissue characterization imaging, including T1-weighted imaging, T2-weighted imaging, and late gadolinium enhancement (LGE) imaging, for the detection of structural changes in patients with monomorphic VAs of LV versus RV origin and negative routine diagnostic work-up; and (2) to determine the prognostic value of concealed structural abnormalities detected by cMRI in these patients. Conclusions-Myocardial Methods Patient PopulationA total of 46 consecutive patients with monomorphic VAs of LV origin (ie, frequent premature ventricular beats [PVBs] >1000/24 hours, nonsustained ventricular tachycardia [NSVT], or sustained ventricular tachycardia [SVT] with right bundle branch block [RBBB] morphology) and negative routine diagnostic work-up were included in the study. Negative routine diagnostic work-up was defined on the basis of (1) absence of systemic diseases, arterial hypertension, and diabetes mellitus; (2) absence of plasma electrolyte abnormalities; (3) normal 12-lead ECG; (4) normal 2-dimensional echocardiography; and (5) absenc...

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Prevalence and Prognostic Value of Concealed Structural Abnormalities in Patients With Apparently Idiopathic Ventricular Arrhythmias of Left Versus Right Ventricular Origin

Nucifora

Muser

Masci

et al. 2014

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

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“…Recent evidence suggests that even a more accurate screening with surface ECG and transthoracic echocardiography (TTE) may not be sensible enough to detect subtle myocardial structural abnormalities . Indeed, when the diagnostic work‐up was implemented with CMR imaging, presence of abnormal myocardial findings could be as high as 50% . Interestingly, when PVCs were identified as truly idiopathic on the basis of accurate screening, they no longer predicted mortality or SCD .…”

Section: Prognosismentioning

confidence: 99%

Detection of concealed structural heart disease by imaging in patients with apparently idiopathic premature ventricular complexes: A review of current literature

Sassone

Muser

Casella

et al. 2019

Clinical Cardiology

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Background Premature ventricular complexes (PVCs) are the most common form of ventricular arrhythmia in the general population. While in most cases PVCs represent a primitive phenomenon with benign behavior, in a non‐negligible proportion of subjects frequent PVCs may be epiphenomenon of underlying occult heart diseases, requiring special medical attention since they have been resulted linked to increased total and cardiac mortality. Nevertheless, PVCs themselves, when incessantly frequent, may be responsible for left ventricular dysfunction in otherwise normal heart. Aim of this narrative review is to update current knowledge on the general approach to patients with frequent PVCs on the basis of available data, with a special focus on the value of imaging. Hypothesis Routine diagnostic work‐up not infrequently miss subtle concealed arrhythmic substrate, leading to erroneously refer to such arrhythmias as to “idiopathic”. Methods Literature search of PVCs articles was conducted in PubMed and Scopus electronic database. Results Conflicting data arise from literature about the true clinical significance of idiopathic PVCs. There is growing body of data providing evidence that more advanced non‐invasive imaging modalities, such as cardiac magnetic resonance, have an incremental diagnostic and prognostic value. On the other hand, in some cases the prognostic significance of isolated subtle myocardial structural abnormalities in patients with PVCs, still remains area of uncertainty. Conclusion In selected subjects with PVCs and high‐risk features for concealed arrhythmic substrate, traditional assessment to rule out the presence of heart disease, including surface ECG and transthoracic echocardiography, should be implemented with more advanced cardiovascular imaging modalities.

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“…Information derived from experiments in animals suggests that the mechanisms by which PVCs are generated include: re-entry, enhanced normal or abnormal automaticity, triggered activity resulting in after depolarisations. It has been showed that evidence for structural heart disease consistent with non-ischemic scarring possibly due to inflammation in patients with PVCs (8). However, prophylactic treatment of asymptomatic PVCs in patients without cardiomyopathy has not been shown to improve mortality.…”

Section: Discussionmentioning

confidence: 99%

“…But there is no clear mortality benefit from PVC suppression in asymptomatic patients. In addition, It has been showed that evidence for structural heart disease consistent with non-ischemic scarring possibly due to inflammation in patients with PVCs (8). This situation suggests that the mechanisms by which PVCs can be also generated with include clinical and subclinical inflammation as well as re-entry, enhanced normal or abnormal automaticity, triggered activity resulting in after depolarizations and also mortality benefit can be related to inhibit clinical and subclinical inflammation rather than triggered activity.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Premature ventricular complexes and Neutrophil–Lymphocyte Ratio in asymptomatic healty young men

et al. 2015

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Background: There is no clear mortality benefit from premature ventricular beat (PVC) suppression in asymptomatic patients. In addition, It has been showed that evidence for structural heart disease consistent with non-ischemic scarring possibly due to inflammation in patients with PVCs. This situation suggests that the mechanisms by which PVCs can be also generated with include clinical and subclinical inflammation. The neutrophil-lymphocyte ratio (NLR) is an easy, cheap, non-invasive, and universally available laboratory marker used to evaluate clinical and subclinical systemic inflammation. We investigated the NLR in asymptomatic healthy young men with PVC (structural heart disease excluded with cardiac magnetic resonance imaging) compared with controls. Methods: 21 asymptomatic (or atypical complaint) healthy young men with PVCs were recruited into the study as they attended to Diyarbakır Military Hospital for screening from January 2013 to December 2014. The control group consisted of 922 male. Instead of Lown's grading of PVCs, we considered as endpoints > 153 PVC over 24 h (in Holter Electrocardiogram). Data were analysed with the SPSS software version 15.0 for Windows. Results: There were no significant differences between the 2 groups with respect to age, gender, body mass index, smoking, as well as glucose, creatinine, total cholesterol, triglyceride, LDL-C, HDL-C, haemoglobin levels, white blood cell count, and red cell distribution width. The NLR was significantly higher among the men with PVC than that of the control group (2.6 ±0.8 vs 2.1 ± 0.7, respectively; P = 0.002). Conclusions: We found that the NLR is significantly elevated in asymptomatic healthy young men with PVC compared with control group. The increased NLR values might indicate subclinical and clinical inflammation in asymptomatic healthy young men with PVC, and we must consider that there can also be inflammation in the one of the mechanisms of PVCs in humans

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Evidence for non-ischemic scarring in patients with ventricular ectopy

Cited by 9 publications

References 24 publications

Prevalence and Prognostic Value of Concealed Structural Abnormalities in Patients With Apparently Idiopathic Ventricular Arrhythmias of Left Versus Right Ventricular Origin

Prevalence and Prognostic Value of Concealed Structural Abnormalities in Patients With Apparently Idiopathic Ventricular Arrhythmias of Left Versus Right Ventricular Origin

Detection of concealed structural heart disease by imaging in patients with apparently idiopathic premature ventricular complexes: A review of current literature

Relationship Between Premature ventricular complexes and Neutrophil–Lymphocyte Ratio in asymptomatic healty young men

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