Abstract 16992: Diagnostic Value of Cardiovascular Magnetic Resonance in Patients With Significant Ventricular Arrhythmia and Normal Echocardiogram
Introduction: Significant ventricular arrhythmia (SVA) (here defined as >5000 ectopics per 24 hours, ventricular tachycardia or ventricular fibrillation) may itself have adverse consequences and/or may point to an underlying structural heart disease. In patients with SVA and normal or non-diagnostic echocardiography, we hypothesized that cardiovascular magnetic resonance (CMR) may detect significant, previously unrecognized structural heart disease.
Methods: We performed a cardiomyopathy contrast CMR protocol in 90 consecutive patients with 1) frequent premature ventricular contractions defined as >5000 premature ventricular beats in a 24-hour Holter (n=57), or 2) non-sustained ventricular tachycardia (n=27), or 3) life threatening ventricular arrhythmia such as sustained ventricular tachycardia, ventricular fibrillation or resuscitated sudden cardiac death (n=6) and 3) normal systolic ventricular function and absence of significant valve disease or left ventricular hypertrophy by echocardiogram.
Results: CMR detected significant abnormalities in 57.8% patients (n=52). These were (number, percentage): late gadolinium enhancement compatible with myocarditis (18, 20.0%), mild left ventricle systolic dysfunction (11, 12.2%), non-compaction cardiomyopathy (7, 7.8%); left ventricle enlargement (7,7.8%); myocardial infarction (4, 4.4 %); left ventricle hypertrophy (4, 4.4%); right ventricle enlargement (3, 3.3%); right ventricle systolic dysfunction (2, 2.2%); and/or one case (3, 3.3%) each of the following: chagasic cardiomyopathy, right ventricular arrhythmogenic dysplasia and left ventricle regional motion abnormality (see figure).
Conclusions: In patients with SVA, the search for structural heart disease should not stop at non-contrast echocardiography and the diagnostic yield of significant ventricular pathology using CMR is greater than 50%.
- © 2013 by American Heart Association, Inc.