Cardiac Magnetic Resonance Imaging in Patients Referred for Premature Ventricular Contractions: is it useful and for which patient? (RF_TH_256)

200 patients were retrospectively included; all referred by their cardiologist after an initial workup including ECG, echocardiography and treadmill exercise ECG test. Images were acquired on a 1.5 and 3 Tesla scanner with a standard protocol (cine imaging for ventricular function and segmental analysis and late gadolinium enhancement sequences after contrast administration). The performance of CMR was defined as the detection of structural abnormalities not previously known or not found on the initial workup.

Results: CMR revealed structural abnormalities in 48% of cases, mainly non-ischemic fibrosis (25.5%) followed by ischemic fibrosis (9%) and mixed fibrosis (2%), as well as the diagnosis of 5 cardiomyopathies. In multivariate analysis, the main predictors of structural abnormalities were age > 64 years (HR 2.23; p=0.028), male sex (HR 2.59; p=0.012), diabetes (HR 6.13; p=0.006), known cardiomyopathy (HR 4.34; p=0.001), and pleomorphic PVCs (HR 3.74; p=0.007). In contrast, left bundle branch block morphology PVCs with inferior axis decreasing with effort in young non-diabetic subjects without known cardiomyopathy and with normal echocardiography all have a normal CMR        

Conclusion:

CMR is essential in the assessment of PVCs as it enables the detection of structural abnormalities not found with the initial workup in almost half of the cases (48%). Predictive factors of structural abnormalities includes men, older than 64 years, diabetic with a known cardiomyopathy and pleomorphic PVCs. On the opposite, young and non –diabetic patients with normal echocardiography and left bundle branch block morphology PVCs with inferior axis decreasing with effort have a normal CMR in 100% and could potentially not need this examination.