Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings.

Raffaele Scorza,Viveka Frykman,Mårten Rosenqvist,Peder Sörensson,Anders Jansson

doi:10.3390/diagnostics11081505

Raffaele Scorza, Viveka Frykman + Show 3 more

Open Access

https://doi.org/10.3390/diagnostics11081505

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Abstract

The prognosis of patients with ventricular ectopy and a normal heart, as evaluated by echocardiography, is virtually unknown. Cardiac magnetic resonance (CMR) can detect focal ventricular anomalies that could act as a possible site of origin for premature ventricular contractions (PVCs). The aim of this study was to investigate the presence of cardiac anomalies in patients with normal findings at echocardiogram. Methods: Fifty-one consecutive patients (23 women, 28 men, mean age 59 years) with very high PVC burden (>10,000 PVC/day) and normal findings at standard echocardiography and exercise test were examined with CMR. The outcome was pathologic findings, defined as impaired ejection fraction, regional wall motion abnormalities, abnormal ventricular volume, myocardial edema and fibrosis. Results: Sixteen out of 51 patients (32%) had structural ventricular abnormalities at CMR. In five patients CMR showed impairment of the left ventricular and/or right ventricular systolic function, and six patients had a dilated left and/or right ventricle. Regional wall motion abnormalities were seen in six patients and fibrosis in four. No patient had CMR signs of edema or met CMR criteria for arrhythmogenic right ventricular cardiomyopathy. Five patients had extra-ventricular findings (enlarged atria in three cases, enlarged thoracic aorta in one case and pericardial effusion in one case). Conclusions: In this study 16 out of 51 patients with a high PVC burden and normal findings at echocardiography showed signs of pathology in the ventricles with CMR. These findings indicate that CMR should be considered in evaluating patients with a high PVC burden and a normal standard investigation.

Highlights

Premature ventricular complexes (PVCs) are common clinical findings, both in patients with and without structural heart disease, and the reported prevalence, it varies among different studies, is high [1,2,3,4,5,6] Whereas premature ventricular contractions (PVCs) are known to be harbingers of poor prognosis in people with previous or current cardiac pathology, there is no agreement about their prognostic impact on subjects without known heart disease [7,8]
A normal echocardiogram was defined as left ventricular ejection fraction (LVEF) equal to or higher than 55%, visually normal right ventricular ejection fraction (RVEF), absence of moderate to severe valve dysfunction, absence of local dyskinesia, normal ventricular dimension, and normal wall thickness
Our findings revealed a possible relation between the site of fibrosis at Cardiac magnetic resonance (CMR) and PVC morphology, indicating that PVCs had their origin in the fibrotic area, which points toward them being an effect of a previous disease

Summary

Introduction

Premature ventricular complexes (PVCs) are common clinical findings, both in patients with and without structural heart disease, and the reported prevalence, it varies among different studies, is high [1,2,3,4,5,6] Whereas PVCs are known to be harbingers of poor prognosis in people with previous or current cardiac pathology, there is no agreement about their prognostic impact on subjects without known heart disease [7,8]. Questions have been raised about whether individuals with a high PVC burden and normal findings at echocardiography are really free of structural heart disease or if more advanced imaging methods are required to identify subtle disease that PVCs could cause or from which they may ensue [9].

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