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Cardiac magnetic resonance predicts outcome in patients with premature ventricular complexes of left bundle branch block morphology.

Abstract：

OBJECTIVES:We investigated whether the presence of right ventricular (RV) abnormalities detected by cardiovascular magnetic resonance (CMR) predict adverse outcome in patients presenting with frequent premature ventricular complexes (PVCs) of left bundle branch block (LBBB) morphology. BACKGROUND:CMR is a component of the diagnostic workup for the differential diagnosis between arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) and idiopathic RV tachycardia. RV abnormalities evaluated by CMR could have prognostic importance. METHODS:Four hundred forty consecutive patients with >1,000 PVCs of LBBB morphology (minor diagnostic criterion of ARVC/D) and no other pre-existing criteria were prospectively enrolled. RV wall motion (WM), signal abnormalities, dilation, and reduced ejection fraction evaluated by CMR were considered imaging criteria of ARVC/D. Follow-up was performed evaluating an index composite end point of 3 cardiac events: cardiac death, resuscitated cardiac arrest, and appropriate implantable cardiac-defibrillator shock. RESULTS:Subjects with multiple RV abnormalities (RVA-2 group) had worse outcome than the no-RVA group (hazard ratio [HR]: 48.6; 95% confidence interval [CI]: 6.1 to 384.8; p < 0.001). Of the 61 patients in the RVA-2 group, only 6 had a definite diagnosis of ARVC/D applying the Task Force Criteria. Also, subjects with a single imaging criterion (RVA-1 group) had worse outcome than the no-RVA group (HR: 18.2; 95% CI: 2.0 to 162.6; p = 0.01). Patients with only WM abnormalities had higher prevalence of cardiac events than no-RVA (HR: 27.2; 95% CI: 3.0 to 244.0; p = 0.03). CONCLUSIONS:In subjects with frequent PVC of LBBB morphology, CMR allows risk stratification. RV abnormalities were associated with worse outcome.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Aquaro GD,Pingitore A,Strata E,Di Bella G,Molinaro S,Lombardi M

doi

10.1016/j.jacc.2010.03.087

subject

Has Abstract

pub_date

2010-10-05 00:00:00

pages

1235-43

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(10)02712-9

journal_volume

pub_type

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Cardiac magnetic resonance predicts outcome in patients with premature ventricular complexes of left bundle branch block morphology.