title: Patients with exercise-associated ventricular ectopy present evidence of myocarditis.
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.
authors.affiliation: Department for Cardiology and Angiology, Heart Center University of Freiburg, Albert-Ludwigs University Freiburg, Freiburg, Germany. info@praxis-jeserich.de.|, Koenigstr. 39, 90402, Nuernberg, Germany. info@praxis-jeserich.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Jeserich
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor str, 68, 1122, Budapest, Hungary. merkely.bela@gmail.com.
authors.forename: Bela
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Department of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany. mol@imbi.uni-freiburg.de.
authors.forename: Manfred
authors.initials: M
authors.lastname: Olschewski
authors.affiliation: Medical Practice, Cardiology and Angiology, Koenigstr. 39, 90402, Nuernberg, Germany. kimmel.simone@gmx.de.
authors.forename: Simone
authors.initials: S
authors.lastname: Kimmel
authors.affiliation: Department of Health Sciences and Sports Medicine, Universitiy of Physical Education, H-1123 Alkotás str. 44, Budapest, Hungary. pavlik@tf.hu.
authors.forename: Gabor
authors.initials: G
authors.lastname: Pavlik
authors.affiliation: Department for Cardiology and Angiology, Heart Center University of Freiburg, Albert-Ludwigs University Freiburg, Freiburg, Germany. christoph.bode@universitaets-herzzentrum.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
mesh_terms: D000368:Aged; D055424:Cardiac-Gated Imaging Techniques; D016022:Case-Control Studies; D003287:Contrast Media; D004489:Edema, Cardiac / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004562:Electrocardiography; D015444:Exercise; D005260:Female; D019786:Gadolinium DTPA; D006339:Heart Rate; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA