Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
JACC Cardiovasc Imaging. 2020 Feb;13(2 Pt 1):410-421. doi: 10.1016/j.jcmg.2019.04.023. Epub 2019 Jul 17.
This study sought to determine whether cardiac magnetic resonance (CMR) may identify structural heart disease (SHD) in patients with ventricular arrhythmia who had echocardiography ruled out pathological findings.
Approximately one-half of sudden cardiac deaths are attributable to malignant VA. Echocardiography is commonly used to identify SHD that is the most frequent substrate of VA.
A single-center prospective study was conducted in consecutive patients with significant VA, categorized as >1,000 but <10,000 ventricular ectopic beats [VEBs]/24 h; ≥10,000 VEBs/24 h; nonsustained ventricular tachycardia, sustained ventricular tachycardia, or a history of resuscitated cardiac arrest, and no pathological findings at echocardiography, requiring a clinically indicated CMR. Primary endpoint was CMR detection of SHD. Secondary endpoints were a composite of CMR detection of SHD and abnormal findings not specific for a definite SHD diagnosis.
A total of 946 patients were enrolled (mean 41 ± 16 years of age; 64% men). CMR studies were used to diagnose SHD in 241 patients (25.5%) and abnormal findings not specific for a definite SHD diagnosis in 187 patients (19.7%). Myocarditis (n = 91) was the more frequent disease, followed by arrhythmogenic cardiomyopathy (n = 55), dilated cardiomyopathy (n = 39), ischemic heart disease (n = 22), hypertrophic cardiomyopathy (n = 13), congenital cardiac disease (n = 10), left ventricle noncompaction (n = 5), and pericarditis (n = 5). The strongest univariate and multivariate predictors of SHD on CMR images were chest pain (odds ratios [OR]: 2.52 and 2.38, respectively) and sustained ventricular tachycardia (ORs: 2.67 and 2.23, respectively).
SHD was able to be identified on CMR imaging in a sizable number of patients with significant VA and completely normal echocardiography. Chest pain and sustained ventricular tachycardia were the strongest predictors of positive CMR imaging results.
本研究旨在确定心脏磁共振（CMR）是否可在经超声心动图排除病理性发现的室性心律失常患者中识别结构性心脏病（SHD）。
大约一半的心脏性猝死归因于恶性室性心律失常。超声心动图常用于识别最常见的室性心律失常基质——结构性心脏病。
这是一项单中心前瞻性研究，连续纳入了室性心律失常程度严重的患者，根据 24 小时内＞1000 但＜10000 个室性异位搏动[VEB]/24 h、≥10000 个 VEB/24 h、非持续性室性心动过速、持续性室性心动过速或心脏骤停复苏史，且超声心动图无异常而需要临床指示行 CMR 的患者进行研究。主要终点为 CMR 检测到 SHD。次要终点为 CMR 检测到 SHD 与不能明确诊断为特定 SHD 的异常发现的复合终点。
共纳入 946 例患者（平均年龄 41±16 岁，64%为男性）。241 例（25.5%）患者行 CMR 检查诊断为 SHD，187 例（19.7%）患者发现不能明确诊断为特定 SHD 的异常发现。最常见的疾病为心肌炎（91 例），其次为致心律失常性右室心肌病（55 例）、扩张型心肌病（39 例）、缺血性心脏病（22 例）、肥厚型心肌病（13 例）、先天性心脏病（10 例）、左心室致密化不全（5 例）和心包炎（5 例）。CMR 图像上 SHD 的最强的单变量和多变量预测因子为胸痛（优势比[OR]：2.52 和 2.38）和持续性室性心动过速（OR：2.67 和 2.23）。
在经超声心动图完全正常的大量室性心律失常患者中，CMR 成像可识别 SHD。胸痛和持续性室性心动过速是 CMR 成像阳性结果的最强预测因子。
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