TY - JOUR
T1 - Risk Stratification of Patients With Apparently Idiopathic Premature Ventricular Contractions
T2 - A Multicenter International CMR Registry
AU - Muser, Daniele
AU - Santangeli, Pasquale
AU - Castro, Simon A.
AU - Casado Arroyo, Ruben
AU - Maeda, Shingo
AU - Benhayon, Daniel A.
AU - Liuba, Ioan
AU - Liang, Jackson J.
AU - Sadek, Mouhannad M.
AU - Chahal, Anwar
AU - Magnani, Silvia
AU - Pieroni, Maurizio
AU - Santarossa, Elena
AU - Desjardins, Benoit
AU - Dixit, Sanjay
AU - Garcia, Fermin C.
AU - Callans, David J.
AU - Frankel, David S.
AU - Alavi, Abass
AU - Marchlinski, Francis E.
AU - Selvanayagam, Joseph B.
AU - Nucifora, Gaetano
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2020/6
Y1 - 2020/6
N2 - 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.
AB - 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.
KW - cardiac magnetic resonance
KW - premature ventricular contractions
KW - sudden cardiac death
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=85082527753&partnerID=8YFLogxK
U2 - 10.1016/j.jacep.2019.10.015
DO - 10.1016/j.jacep.2019.10.015
M3 - Article
C2 - 32553224
AN - SCOPUS:85082527753
SN - 2405-500X
VL - 6
SP - 722
EP - 735
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 6
ER -