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Diagnostic power of Cardiac Magnetic Resonance in unexplained or suspected arrhythmias
Session:
Painel 3 - Imagiologia Cardiovascular 3
Speaker:
Rita Rocha
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Posters
FP Number:
---
Authors:
Rita Caldeira Da Rocha; Bruno Cordeiro Piçarra; Antonio; Ana Rita Santos; Mafalda Carrington; Diogo Brás; Rui Azevedo Guerreiro; Renato Fernandes; José Eduardo Aguiar
Abstract
<p><strong>Introduction:</strong> Etiology of cardiac arrhythmias is often difficult to determine. As the gold standard to anatomical and functional cardiac evaluation, Cardiac Magnetic Resonance (CMR) can be a fundamental technique for accurate assessment of myocardial arrhythmic substrates or for arrhythmias management.</p> <p><strong>Purpose:</strong> The aim of this study is to determine diagnostic and arrhythmic risk stratification impact of CMR performed in patients with suspected or confirmed arrhythmias.</p> <p><strong>Methods:</strong> We performed a six- years prospective study of patients with suspected or confirmed arrhythmias which evaluation with other techniques did not provide a definitive diagnosis. These patients underwent CMR for diagnostic and risk stratification assessment. We applied a protocol to evaluate both ventricles’ morphology and functional and late gadolinium enhancement (LGE) presence.</p> <p><strong>Results</strong><strong>:</strong> A total of 93 patients were included, of which 66% were male, with a mean age of 45±17 years old. The indications for patients with suspected or confirmed arrhythmias performing CMR evaluation were the following: 33% (n=31) of the patients had very frequent premature ventricular complexes, 23% (n=21) had sustained ventricular tachycardia (VT), 5%(n=5) non-sustained VT, 17%(n=16) suspected structural heart disease with high arrhythmic potential,10%(n=9) unexplained recurrent syncope,9 %(n=8) supraventricular tachycardia and 3% (n=3) aborted sudden cardiac death. Depressed ejection fraction (<50%) was foundin 10% (n=9) for LV(mean EF 38±9%) and 15%(n=14) for RV(mean EF 42±7%). Dilation of LV was found in 25% of patients (n=23, mean LV volume: 115±7ml/m²), with RV dilation being present in only 1 patient, who had right ventricle arrhythmogenic dysplasia (RVAD) (RV volume: 152ml/m²). In total, 16%had interventricular septum hypertrophy (mean 15±4mm/m<sup>2</sup>).We found slight anterior leaflet prolapse of mitral valve in 10% (n=9) of cases and mild mitral regurgitation in 15% (n=14). Left atrium dilation was observed in 17% (n=16) of cases (mean area of 18±2cm<sup>2</sup>/m<sup>2</sup>), as right atrium was dilated in only two. In 20% of the patients, CMR contributed to establish a previously unknown diagnosis: 6% (n=5) have hypertrophic cardiomyopathy, 4% (n=4) a myocarditis sequelae and 2%(n=2) had RVAD. LV non-compaction, a silent myocardial infarction scar and non-ischemic dilated cardiomyopathy were diagnosed in 3% of cases each. In 15% (n=14) we found nonspecific variations, which deserve follow-up. On the remaining patients, CMR was considered normal.</p> <p><strong>Conclusion</strong><strong>: </strong>As a high reproducible, accurate and versatile technique, CMR allowed an increase on diagnosis in 20% of the patients with suspected or confirmed arrhythmias. Consequently, it contributed to the risk stratification of our study population with suspected high arrhythmic potential when the first-line complementary exams were inconclusive.</p>
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