Patients with exercise-associated ventricular ectopy present evidence of myocarditis

Abstract

BackgroundThe origin and clinical relevance of exercise-induced premature ventricular beats (PVBs) in patients without coronary heart disease or cardiomyopathies is unknown. Cardiovascular magnetic resonance enables us to non-invasively assess myocardial scarring and oedema. The purpose of our study was to discover any evidence of myocardial anomalies in patients with exercise-induced ventricular premature beats.MethodsWe examined 162 consecutive patients presenting palpitations and documented exercise-induced premature ventricular beats (PVBs) but no history or evidence of structural heart disease. Results were compared with 70 controls matched for gender and age. ECG-triggered, T2-weighted, fast spin echo triple inversion recovery sequences and late gadolinium enhancement were obtained as well as LV function and dimensions.ResultsStructural anomalies in the myocardium and/or pericardium were present in 85 % of patients with exercise-induced PVBs. We observed a significant difference between patients with PVBs and controls in late gadolinium enhancement, that is 68 % presented subepicardial or midmyocardial lesions upon enhancement, whereas only 9 % of the controls did so (p < 0.0001). More patients presented pericardial enhancement (35 %) or pericardial thickening (27 %) compared to controls (21 % and 13 %, p < 0.0001). Myocardial oedema was present in 37 % of the patients and in only one control, p < 0.0001. Left ventricular ejection fraction did not differ between patients and controls (63.1 ± 7.9 vs. 64.7 ± 7.0, p = 0.13).ConclusionsThe majority of patients with exercise-associated premature ventricular beats present evidence of myocardial disease consistent with acute or previous myocarditis or myopericarditis.

Concurrent Exercise-Associated Ventricular Complexes and a Prolonged QT Interval are Associated with Evidence of Myocarditis

“…We analyzed retrospectively the 162 consecutive patients referred to our department for palpitations, thoracic pain or dyspnea who developed PVCs during exercise testing as reported before [13]. and compared them to 182 age-and sex-matched controls without exerciseinduced PVCs.…”

“…In addition to 2, 3 and 4-chamber long-axis views, 3-D short-axis volume data was acquired by steadystate free precession imaging to evaluate LV function and dimensions. Phase-contrast velocity images in the ascending aorta were obtained to measure stroke volume and rule out significant aortic insufficiency as described previously [13,15,16]. Functional and morphological data were evaluated using view forum 6.5.…”

“…A detailed analysis of QT and QTc intervals in patients with exercise-associated PVCs has not been published to date. We therefore compared the QT and QTc intervals of 162 consecutive patients we examined before and of whom 85% showed evidence of myocardial disease consistent with acute or previous myocarditis or myopericarditis [13] and compared these patients to a control group without PVCs. We hypothesized that exercise-associated PVCs due to remote or acute myocarditis may be associated with QT interval changes.…”

“…All patients but no controls underwent ECG-triggered, T2-weighted, fast spin echo triple inversion recovery sequences (STIR) in a short axis view covering the whole left ventricle as described in our earlier studies [13,15,16]. Late gadolinium enhancement (LGE) imaging was obtained in all patients 10 minutes after iv administration of 0.2 mmol/kg gadolinium-diethylenetriaminepentaacetate using 3D inversion recovery turbo gradient echo sequences as described previously [13,15,16].…”

“…Late gadolinium enhancement (LGE) imaging was obtained in all patients 10 minutes after iv administration of 0.2 mmol/kg gadolinium-diethylenetriaminepentaacetate using 3D inversion recovery turbo gradient echo sequences as described previously [13,15,16].…”