Author + information
- Received May 9, 2019
- Revision received October 9, 2019
- Accepted October 17, 2019
- Published online June 15, 2020.
- Daniele Muser, MDa,b,∗,
- Pasquale Santangeli, MD, PhDa,∗,
- Simon A. Castro, MDa,
- Ruben Casado Arroyo, MD, PhDc,
- Shingo Maeda, MDd,
- Daniel A. Benhayon, MDe,
- Ioan Liuba, MDf,
- Jackson J. Liang, DOa,
- Mouhannad M. Sadek, MDg,
- Anwar Chahal, MDa,
- Silvia Magnani, MDh,
- Maurizio Pieroni, MDi,
- Elena Santarossa, MDb,
- Benoit Desjardins, MD, PhDj,
- Sanjay Dixit, MDa,
- Fermin C. Garcia, MDa,
- David J. Callans, MDa,
- David S. Frankel, MDa,
- Abass Alavi, MD, PhDj,
- Francis E. Marchlinski, MDa,
- Joseph B. Selvanayagam, MBBS(Hons), DPhilk and
- Gaetano Nucifora, MD, PhDk,l,∗ ()
- aCardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- bCardiothoracic Department, Santa Maria della Misericordia University Hospital, Udine, Italy
- cCardiology Department, Université Libre de Bruxelles, Brussels, Belgium
- dHeart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
- eCardiac Electrophysiology, Memorial Healthcare System, Hollywood, Florida
- fDivision of Electrophysiology, Department of Cardiology, University Hospital Linköping, Linköping, Sweden
- gCardiac Electrophysiology, University of Ottawa Heart Institute, Ottawa, Canada
- hCardiac Electrophysiology/Heart Rhythm Center, New York University, New York, New York
- iCardiovascular Department, San Donato Hospital, Arezzo, Italy
- jRadiology Department, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- kDepartment of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia
- lCardiac Imaging Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- ↵∗Address for correspondence:
Dr. Gaetano Nucifora, Cardiac Imaging Unit, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom.
Objectives This study investigated the prevalence and prognostic significance of concealed myocardial abnormalities identified by cardiac magnetic resonance (CMR) imaging in patients with apparently idiopathic premature ventricular contractions (PVCs).
Background The role of CMR imaging in patients with frequent PVCs and otherwise negative diagnostic workup is uncertain.
Methods This was a multicenter, international study that included 518 patients (age 44 ± 15 years; 57% men) with frequent (>1,000/24 h) PVCs and negative routine diagnostic workup. Patients underwent a comprehensive CMR protocol including late gadolinium enhancement imaging for detection of necrosis and/or fibrosis. The study endpoint was a composite of sudden cardiac death, resuscitated cardiac arrest, and nonfatal episodes of ventricular fibrillation or sustained ventricular tachycardia that required appropriate implantable cardioverter-defibrillator therapy.
Results Myocardial abnormalities were found in 85 (16%) patients. Male gender (odds ratio [OR]: 4.28; 95% confidence interval [CI]: 2.06 to 8.93; p = 0.01), family history of sudden cardiac death and/or cardiomyopathy (OR: 3.61; 95% CI: 1.33 to 9.82; p = 0.01), multifocal PVCs (OR: 11.12; 95% CI: 4.35 to 28.46; p < 0.01), and non–left bundle branch block inferior axis morphology (OR: 14.11; 95% CI: 7.35 to 27.07; p < 0.01) were all significantly related to the presence of myocardial abnormalities. After a median follow-up of 67 months, the composite endpoint occurred in 26 (5%) patients. Subjects with myocardial abnormalities on CMR had a higher incidence of the composite outcome (n = 25; 29%) compared with those without abnormalities (n = 1; 0.2%; p < 0.01).
Conclusions CMR can identify concealed myocardial abnormalities in 16% of patients with apparently idiopathic frequent PVCs. Presence of myocardial abnormalities on CMR predict worse clinical outcomes.
- cardiac magnetic resonance
- premature ventricular contractions
- sudden cardiac death
- ventricular tachycardia
↵∗ Drs. Muser and Santangeli contributed equally to this work and are joint first authors.
This study was funded in part by the Richard T. and Angela Clark Innovation Fund and the Mark S. Marchlinski Research Fund in Cardiac Electrophysiology. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 9, 2019.
- Revision received October 9, 2019.
- Accepted October 17, 2019.
- 2019 American College of Cardiology Foundation
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