Cardiac Magnetic Resonance to Detect the Underlying Substrate in Patients with Frequent Idiopathic Ventricular Arrhythmias
Chrysovalantou Nikolaidou,
Christos P. Kotanidis,
Rohan Wijesurendra,
Joana Leal-Pelado,
Konstantinos Kouskouras,
Vassilios P. Vassilikos,
Haralambos Karvounis,
Ntobeko Ntusi,
Charalambos Antoniades,
Stefan Neubauer,
Theodoros D. Karamitsos
Affiliations
Chrysovalantou Nikolaidou
Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK
Christos P. Kotanidis
Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
Rohan Wijesurendra
Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK
Joana Leal-Pelado
Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK
Konstantinos Kouskouras
Department of Radiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece
Vassilios P. Vassilikos
Third Department of Cardiology, Hippokration Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 43 Thessaloniki, Greece
Haralambos Karvounis
First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece
Ntobeko Ntusi
Department of Medicine, University of Cape Town and Groote Schuur Hospital, 7925 Cape Town, South Africa
Charalambos Antoniades
Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
Stefan Neubauer
Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford OX3 9DU, UK
Theodoros D. Karamitsos
First Department of Cardiology, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece
Background: A routine diagnostic work-up does not identify structural abnormalities in a substantial proportion of patients with idiopathic ventricular arrhythmias (VAs). We investigated the added value of cardiac magnetic resonance (CMR) imaging in this group of patients. Methods: A single-centre prospective study was undertaken of 72 patients (mean age 46 ± 16 years; 53% females) with frequent premature ventricular contractions (PVCs ≥ 500/24 h) and/or non-sustained ventricular tachycardia (NSVT), an otherwise normal electrocardiogram, normal echocardiography and no coronary artery disease. Results: CMR provided an additional diagnostic yield in 54.2% of patients. The most prevalent diagnosis was previous myocarditis (23.6%) followed by possible PVC-related cardiomyopathy (20.8%), non-ischaemic cardiomyopathy (8.3%) and ischaemic heart disease (1.4%). The predictors of abnormal CMR findings were male gender, age and PVCs/NSVT non-outflow tract-related or with multiple morphologies. Patients with VAs had an impaired peak left ventricular (LV) global radial strain (GRS) compared with the controls (28.88% (IQR: 25.87% to 33.97%) vs. 36.65% (IQR: 33.19% to 40.2%), p p < 0.001). Conclusion: CMR reveals abnormalities in a significant proportion of patients with frequent idiopathic VAs. Male gender, age and non-outflow tract PVC origin can be clinical indicators for CMR referral.
