Cardiac magnetic resonance predicts outcome in patients with premature ventricular complexes of left bundle branch block morphology
- PMID: 20883930
- DOI: 10.1016/j.jacc.2010.03.087
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.
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Comment in
-
The use of cardiovascular magnetic resonance to identify adverse cardiac prognosis: an important step in reducing image-related heath care expenditures.J Am Coll Cardiol. 2010 Oct 5;56(15):1244-6. doi: 10.1016/j.jacc.2010.07.011. J Am Coll Cardiol. 2010. PMID: 20883931 Free PMC article. No abstract available.
-
Cardiac magnetic resonance for risk stratification of patients with frequent premature ventricular contractions.J Am Coll Cardiol. 2011 Apr 12;57(15):1636-7; author reply 1637-8. doi: 10.1016/j.jacc.2010.11.039. J Am Coll Cardiol. 2011. PMID: 21474047 No abstract available.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources