Myocardial structural abnormalities detected by cMRI in patients with apparently idiopathic monomorphic VAs were significantly associated with worse arrhythmic outcomes (HR 41.6; 95% CI 5.2-225.0; P<0.001).
Cohort (n=120)
Does cardiac MRI detect concealed structural abnormalities and predict arrhythmic outcomes in patients with apparently idiopathic monomorphic ventricular arrhythmias of left versus right ventricular origin?
Cardiac MRI detects concealed structural abnormalities in a significant proportion of patients with apparently idiopathic left ventricular arrhythmias, and these abnormalities strongly predict adverse arrhythmic outcomes.
Effect estimate: HR 41.6 (95% CI 5.2-225.0)
p-value: p=<0.001
BACKGROUND: Routine diagnostic work-up occasionally does not identify any abnormality among patients with monomorphic ventricular arrhythmias (VAs) of left ventricular (LV) origin. Aim of this study was to investigate the value of cardiac MRI (cMRI) for the diagnostic work-up and prognostication of these patients. METHODS AND RESULTS: Forty-six consecutive patients (65% males; mean age, 44±15 years) with monomorphic VAs of LV origin and negative routine diagnostic work-up were included. Seventy-four consecutive patients (60% males; mean age, 40±17 years) with apparently idiopathic monomorphic VAs of right ventricular origin served as control group. Both groups underwent comprehensive cMRI study and were followed-up for a median of 14 months (25th-75th percentiles, 7-37 months). The outcome event was an arrhythmic composite end point of sudden cardiac death or nonfatal episode of ventricular fibrillation or sustained ventricular tachycardia requiring external cardioversion or appropriate implantable cardioverter defibrillator therapy. The 2 groups of patients did not differ in age (P=0.14) and sex (P=0.57). No significant difference was observed between patients with VAs of LV origin and VAs of right ventricular origin about biventricular volumes and systolic function. cMRI demonstrated myocardial structural abnormalities in 19 (41%) patients with VAs of LV origin versus 4 (5%) patients with VAs of right ventricular origin (P<0.001). The outcome event occurred in 9 patients; myocardial structural abnormalities on cMRI were significantly related to the outcome event (hazard ratio, 41.6; 95% confidence interval, 5.2-225.0; P<0.001). CONCLUSIONS: Myocardial structural changes are detected by cMRI in a non-negligible proportion of patients with apparently idiopathic monomorphic VAs of LV origin and are associated with worse outcome.
Nucifora et al. (Sat,) conducted a cohort in Apparently idiopathic monomorphic ventricular arrhythmias (n=120). Cardiac MRI (cMRI) vs. Patients with VAs of right ventricular origin was evaluated on Arrhythmic composite end point of sudden cardiac death or nonfatal episode of ventricular fibrillation or sustained ventricular tachycardia requiring external cardioversion or appropriate implantable cardioverter defibrillator therapy (HR 41.6, 95% CI 5.2-225.0, p=<0.001). Myocardial structural abnormalities detected by cMRI in patients with apparently idiopathic monomorphic VAs were significantly associated with worse arrhythmic outcomes (HR 41.6; 95% CI 5.2-225.0; P<0.001).