Prevalence and prognostic value of concealed structural abnormalities in patients with apparently idiopathic ventricular arrhythmias of left versus right ventricular origin: a magnetic resonance imaging study.
BACKGROUND
Routine diagnostic work-up occasionally does not identify any abnormality among patients with monomorphic ventricular arrhythmias (VAs) of left ventricular (LV) origin. Aim of this study was to investigate the value of cardiac MRI (cMRI) for the diagnostic work-up and prognostication of these patients.


RESULTS
Forty-six consecutive patients (65% males; mean age, 44±15 years) with monomorphic VAs of LV origin and negative routine diagnostic work-up were included. Seventy-four consecutive patients (60% males; mean age, 40±17 years) with apparently idiopathic monomorphic VAs of right ventricular origin served as control group. Both groups underwent comprehensive cMRI study and were followed-up for a median of 14 months (25th-75th percentiles, 7-37 months). The outcome event was an arrhythmic composite end point of sudden cardiac death or nonfatal episode of ventricular fibrillation or sustained ventricular tachycardia requiring external cardioversion or appropriate implantable cardioverter defibrillator therapy. The 2 groups of patients did not differ in age (P=0.14) and sex (P=0.57). No significant difference was observed between patients with VAs of LV origin and VAs of right ventricular origin about biventricular volumes and systolic function. cMRI demonstrated myocardial structural abnormalities in 19 (41%) patients with VAs of LV origin versus 4 (5%) patients with VAs of right ventricular origin (P<0.001). The outcome event occurred in 9 patients; myocardial structural abnormalities on cMRI were significantly related to the outcome event (hazard ratio, 41.6; 95% confidence interval, 5.2-225.0; P<0.001).


CONCLUSIONS
Myocardial structural changes are detected by cMRI in a non-negligible proportion of patients with apparently idiopathic monomorphic VAs of LV origin and are associated with worse outcome.
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.). gnucifora@cardionet.it.
Gaetano
G
Nucifora
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Daniele
D
Muser
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Pier Giorgio
PG
Masci
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Andrea
A
Barison
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Luca
L
Rebellato
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Gianluca
G
Piccoli
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Elisabetta
E
Daleffe
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Mauro
M
Toniolo
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Davide
D
Zanuttini
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Domenico
D
Facchin
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Massimo
M
Lombardi
From the Division of Cardiology (G.N., D.M., L.R., E.D., M.T., D.Z., D.F., A.P.) and the Division of Diagnostic Angiography and Interventional Radiology (G.P.), University Hospital "Santa Maria della Misericordia," Udine, Italy; Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy (D.M.); Magnetic Resonance Imaging Department, Fondazione CNR/Regione Toscana "Gabriele Monasterio," Pisa, Italy (P.G.M., A.B.); Multimodality Cardiac Imaging Section, I.R.C.C.S. Policlinico San Donato, Milan, Italy (M.L.); and I.R.C.A.B. Foundation, Udine, Italy (A.P.).
Alessandro
A
Proclemer
D000328:Adult; D017115:Catheter Ablation / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology; D006352:Heart Ventricles / Q000002:abnormalities / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
arrhythmias, cardiac; arrhythmogenic right ventricular dysplasia; fibrosis; heart ventricles; magnetic resonance imaging; myocarditis; prognosis