Key result
Ventricular arrhythmia in myocarditis was associated with more frequent (94% vs 69%; p=0.016) and extensive (17.6% vs 8.2% of myocardial mass; p<0.001) late gadolinium enhancement on CMR.
Why the study?
Ventricular arrhythmia is a frequent presentation of myocarditis, but its characteristics and prognostic relevance remained to be investigated.
What are the clinical and imaging characteristics associated with ventricular arrhythmia in patients with myocarditis?
Case-Control (n=76)
What are the clinical and imaging characteristics associated with ventricular arrhythmia in patients with myocarditis?
In patients with myocarditis, ventricular arrhythmias are associated with more frequent and extensive late gadolinium enhancement on CMR, rather than reduced left ventricular ejection fraction.
Extensive LGE on CMR associates with VA in myocarditis; hypothesis-generating for refined risk stratification.
Myocarditis is characterized by various clinical manifestations, with ventricular arrhythmia (VA) as a frequent symptom at initial presentation. Here, we investigated characteristics and prognostic relevance of VA in patients with myocarditis. The study population consisted of 76 patients with myocarditis, verified by biopsy and/or cardiac magnetic resonance (CMR) imaging, including 38 consecutive patients with VA (45 ± 3 years, 68% male) vs. 38 patients without VA (NVA) (38 ± 2 years, 84% male) serving as a control group. VA was monomorphic ventricular tachycardia in 55% of patients, premature ventricular complexes in 50% and ventricular fibrillation in 29%. The left ventricular ejection fraction at baseline was 47 ± 2% vs. 40 ± 3% in VA vs. NVA patients (p = 0.069). CMR showed late gadolinium enhancement more often in VA patients (94% vs. 69%; p = 0.016), incorporating 17.6 ± 1.8% vs. 8.2 ± 1.3% of myocardial mass (p < 0.001). Radiofrequency catheter ablation for VA was initially performed in nine (24%) patients, of whom five remained free from any recurrence over 24 ± 3 months. Taken together, in patients with myocarditis, reduced left ventricular ejection fraction does not predict VA occurrence but CMR shows late gadolinium enhancement more frequently and to a larger extent in VA than in NVA patients, potentially guiding catheter ablation as a reasonable treatment of VA in this population.
No takes yet. Share an insight, caveat, or question.
Kahle et al. (2022) conducted a case-control in Myocarditis (n=76). Ventricular arrhythmia vs. No ventricular arrhythmia was evaluated on Late gadolinium enhancement on CMR (p=0.016). Ventricular arrhythmia in myocarditis was associated with more frequent (94% vs 69%; p=0.016) and extensive (17.6% vs 8.2% of myocardial mass; p<0.001) late gadolinium enhancement on CMR.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: