Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction.

George Markousis-Mavrogenis,Paraskevi Voulgari,George D Kitas,George D Kitas,George Poulos,Dionysia Manolopoulou,Clio Mavragani,Sophie I Mavrogeni,Sophie I Mavrogeni,Vasiliki Vartela,Genovefa Kolovou,Theodoros Dimitroulas,Petros P Sfikakis,Petros P Sfikakis,Aikaterini Giannakopoulou

doi:10.3390/diagnostics11030519

Abstract

Non-sustained ventricular tachycardia (NSVT) is a potentially lethal arrhythmia that is most commonly attributed to coronary artery disease. We hypothesised that among patients with NSVT and preserved ejection fraction, cardiovascular magnetic resonance (CMR) would identify a different proportion of ischaemic/non-ischaemic arrhythmogenic substrates in those with and without autoimmune rheumatic diseases (ARDs). In total, 80 consecutive patients (40 with ARDs, 40 with non-ARD-related cardiac pathology) with NSVT in the past 15 days and preserved left ventricular ejection fraction were examined using a 1.5-T system. Evaluated parameters included biventricular volumes/ejection fractions, T2 signal ratio, early/late gadolinium enhancement (EGE/LGE), T1 and T2 mapping and extracellular volume fraction (ECV). Mean age did not differ across groups, but patients with ARDs were more often women (32 (80%) vs. 15 (38%), p < 0.001). Biventricular systolic function, T2 signal ratio and EGE and LGE extent did not differ significantly between groups. Patients with ARDs had significantly higher median native T1 mapping (1078.5 (1049.0–1149.0) vs. 1041.5 (1014.0–1079.5), p = 0.003), higher ECV (31.0 (29.0–32.0) vs. 28.0 (26.5–30.0), p = 0.003) and higher T2 mapping (57.5 (54.0–61.0) vs. 52.0 (48.0–55.5), p = 0.001). In patients with ARDs, the distribution of cardiac fibrosis followed a predominantly non-ischaemic pattern, with ischaemic patterns being more common in those without ARDs (p < 0.001). After accounting for age and cardiovascular comorbidities, most findings remained unaffected, while only tissue characterisation indices remained significant after additionally correcting for sex. Patients with ARDs had a predominantly non-ischaemic myocardial scar pattern and showed evidence of diffuse inflammatory/ischaemic changes (elevated native T1-/T2-mapping and ECV values) independent of confounding factors.

Highlights

In patients with autoimmune rheumatic diseases (ARDs), development of arrhythmogenic inflammatory cardiomyopathy can lead to out-of-hospital cardiac arrest (OHCA)and can potentially cause sudden cardiac death (SCD) [1,2]
By using cardiovascular magnetic resonance (CMR), we examined potential arrhythmogenic substrates leading to Non-sustained ventricular tachycardia (NSVT) in patients with and without ARDs and a preserved left ventricular ejection fraction (LVEF), while aiming to identify CMR indices that can optimally discriminate between the two groups
We present for the first time a comparison of patients with a recent history of non-sustained ventricular tachycardia and a preserved left ventricular ejection fraction with and without a diagnosis of ARDs

Summary

Introduction

In patients with autoimmune rheumatic diseases (ARDs), development of arrhythmogenic inflammatory cardiomyopathy can lead to out-of-hospital cardiac arrest (OHCA)and can potentially cause sudden cardiac death (SCD) [1,2]. An important challenge in the context of OHCA is that the majority of patients experience it as a first presentation, often without previous symptoms or a diagnosed cardiac condition [3]. This makes primary prevention a daunting task. The occurrence of VT/VF is prevalent in numerous ARDs and has been described, among others, in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), giant cell myocarditis (GCM) and systemic sclerosis (SSc) [5,6,7,8,9] This arrhythmogenicity was traditionally attributed to ventricular scarring leading to re-entrant

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