SPC365

Ventricular Arrhythmia in patients with normal echocardiography – can Cardiovascular Magnetic Resonance enhance the diagnosis of structural heart disease?

Session: Posters (Sessão 6 - Écran 1) - Imagem 3 - RM Cardíaca e Cardiologia Nuclear
Speaker: Catarina Costa

Congress: CPC 2022
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.3 Cardiac Magnetic Resonance
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Catarina Martins da Costa; João Calvão; Ana Filipa Amador; Ricardo Alves Pinto; Catarina Amaral Marques; André Cabrita; Ana Isabel Pinho; Luís Daniel Santos; Cátia Oliveira; António j Madureira; Gonçalo Pestana; Ana Lebreiro; Luis Adão; Teresa Pinho; Filipe Macedo

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Background:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> Ventricular arrhythmias (VA) include a broad spectrum ranging from premature ventricular beats (VPBs) to ventricular fibrillation (VF) and account for approximately 50% of all cardiovascular deaths. Echocardiography is commonly used to identify structural heart disease (SHD), the most frequent substrate of VA. Cardiovascular magnetic resonance (CMR) is recommended to complement echocardiography when image quality is suboptimal.</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Purpose:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> This retrospective study sought to determine whether CMR may identify SHD in patients (pts) with VA, who had normal baseline ECG and whose echocardiogram, with adequate technical conditions, ruled out pathological findings.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Methods:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> We included consecutive pts followed in the arrythmia outpatient clinic of one tertiary center from June 2014 to June 2021 for significant VA. This was categorized as &gt;1,000 but &lt;10,000 VPBs/24 h; &ge;10,000 VPBs/24 h; nonsustained ventricular tachycardia (NSVT), sustained VT, or a history of resuscitated cardiac arrest, and no pathological findings at echocardiography, requiring a clinically indicated CMR. The primary endpoint was detection of SHD on CMR. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> A total of 75 pts were included. Fifty-nine pts had no SHD (mean age 45 &plusmn; 15 years old) and 16 pts presented signs of SHD (mean age 53&plusmn;15 years old). All pts performed CMR, and Table 1 shows pts&rsquo; baseline characteristics, VA diagnosis and CMR measurements. Definite SHD was diagnosed in 8 patients (11%): ischemic cardiopathy (three pts), myocarditis (1 pt), hypertrophic cardiomyopathy (1pt), right ventricle arrhythmogenic disease (1 pt), non-compaction cardiomyopathy (1pt); 1 patient presented higher myocardial T2 signal and was later diagnosed with sarcoidosis. Furthermore, abnormal findings not specific for a definite SHD diagnosis were found in 8 additional pts (10%) who showed unspecific intra-myocardium enhancement. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Discussion and Conclusion:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> CMR imaging identified SHD in about 20% of patients with normal ECG and echocardiogram. Among patients with a definite SHD diagnosis, ischemic cardiopathy was the most common finding, unlike previous studies showing myocarditis as the main cause. This finding may be related to the older age of SHD group. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">In conclusion, CMR allowed diagnosis of clinically relevant SHD even when echocardiography excluded it. </span></span></span></span></span></p>