Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Nov 21:17:100.
doi: 10.1186/s12968-015-0204-3.

Patients with exercise-associated ventricular ectopy present evidence of myocarditis

Michael Jeserich  1   2 , Bela Merkely  3 , Manfred Olschewski  4 , Simone Kimmel  5 , Gabor Pavlik  6 , Christoph Bode  7
Affiliations

Patients with exercise-associated ventricular ectopy present evidence of myocarditis

Michael Jeserich et al. J Cardiovasc Magn Reson. .

Abstract

Background: The origin and clinical relevance of exercise-induced premature ventricular beats (PVBs) in patients without coronary heart disease or cardiomyopathies is unknown. Cardiovascular magnetic resonance enables us to non-invasively assess myocardial scarring and oedema. The purpose of our study was to discover any evidence of myocardial anomalies in patients with exercise-induced ventricular premature beats.

Methods: We examined 162 consecutive patients presenting palpitations and documented exercise-induced premature ventricular beats (PVBs) but no history or evidence of structural heart disease. Results were compared with 70 controls matched for gender and age. ECG-triggered, T2-weighted, fast spin echo triple inversion recovery sequences and late gadolinium enhancement were obtained as well as LV function and dimensions.

Results: Structural anomalies in the myocardium and/or pericardium were present in 85 % of patients with exercise-induced PVBs. We observed a significant difference between patients with PVBs and controls in late gadolinium enhancement, that is 68 % presented subepicardial or midmyocardial lesions upon enhancement, whereas only 9 % of the controls did so (p < 0.0001). More patients presented pericardial enhancement (35 %) or pericardial thickening (27 %) compared to controls (21 % and 13 %, p < 0.0001). Myocardial oedema was present in 37 % of the patients and in only one control, p < 0.0001. Left ventricular ejection fraction did not differ between patients and controls (63.1 ± 7.9 vs. 64.7 ± 7.0, p = 0.13).

Conclusions: The majority of patients with exercise-associated premature ventricular beats present evidence of myocardial disease consistent with acute or previous myocarditis or myopericarditis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
An exemplary T2-weighted (STIR) image of a 57 year old female patient with a viral respiratory viral infection 3 weeks ago and exercise induced PVBs. Globally enhanced signal intensity of the myocardium of the left ventricle (arrows) compared to skeletal muscle. The ratio of signal intensity between myocardial and skeletal muscle was elevated (2.26). LV: Left ventricle. RV: Right ventricle. SM: Skeletal muscle
Fig. 2
Fig. 2
a/b Late-enhancement image of one patient with exercise induced PVBs. Note the patchy enhancement of the midwall septal (↑) and lateral wall (↑↑). Four and two-chamber view. LV: Left ventricle. RV: Right ventricle
Fig. 3
Fig. 3
Late-enhancement image of a 59 year old female with long lasting respiratory tract infect, palpitations and exercise induced PVBs. Enhancement of the midwall septal (↑) and lateral wall (↑↑). In addition, lateral pericardial enhancement is visible (↓) Four-chamber view. LV: Left ventricle. RV: Right ventricle
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Alpert MA, Mukerji V, Bikkina M, Concannon MD, Hashimi MW. Pathogenesis, recognition, and management of common cardiac arrhythmias. Part I: ventricular premature beats and tachyarrhythmias. South Med J. 1995;88:1–21. doi: 10.1097/00007611-199501000-00001. - DOI - PubMed
    1. Niwano S, Wakisaka Y, Niwano H, Fukaya H, Kurokawa S, Kiryu M, et al. Prognostic significance of frequent premature ventricular contractions originating from the ventricular outflow tract in patients with normal left ventricular function. Heart. 2009;95:1230–7. doi: 10.1136/hrt.2008.159558. - DOI - PubMed
    1. Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, Goldberg RJ. Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. N Engl J Med. 1985;312:193–7. doi: 10.1056/NEJM198501243120401. - DOI - PubMed
    1. Gaita F, Giustetto C, Di Donna P, Richiardi E, Libero L, Brusin MC, et al. Long-term follow-up of right ventricular monomorphic extrasystoles. J Am Coll Cardiol. 2001;38:364–70. doi: 10.1016/S0735-1097(01)01403-6. - DOI - PubMed
    1. Jouven X, Zureik M, Desnos M, Courbon D, Ducimetière P. Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations. N Engl J Med. 2000;343:826–33. doi: 10.1056/NEJM200009213431201. - DOI - PubMed

MeSH terms