Symptoms related to the sudden occurrence of ventricular arrhythmias (VA) remains frequently a diagnostic and therapeutic challenge,
after exclusion of coronary artery disease ,
being related to a wide spectrum of myocardial disease (1).
Aim was to evaluate the role of cardiacMR and Delayed Enhanced Computed Tomography in the identification of myocardial disease responsible of ventricular arrhythmias onset,
comparing imaging findings to histological essays.
Methods and Materials
16 patients (XX/XY: 2/14,
mean FE: 50%±5%) with sudden occurrence of palpitation/lipothymia-hypotension related to the onset of previously unknown ventricular arrhythmias were enrolled.
13 patients underwent cardiacMR including T2w sequences sensitive to edema and IR T1w sequences acquired 10-15 min after gadolinium injection,
the remaing 3 patients with controindication to CMR, were stuided with Computed Tomography including a delayed low-energy (80 kV) scan for scars identification.
endomyocardial biopsy was performed,
and results compared to imaging findings.
In 13/16 patients myocardial features at non invasive cardiac imaging were suggestive for inflammatory cardiomyopathy (5/16 acute myocarditis (Fig.1),
7/16 prior myocarditis (Fig.2),
1/16 cardiac sarcoid (Fig.3).
In the remaing three cases cardiac imaging evidentiating amiloidosis,
left ventricle non compaction and initial idiopathic dilated cardiomyopathy.
Endomyocardial byopsy confirmed the imaging diagnosis in 14 out of 16 patients; 1 patients with evidence of focal myocarditis at CMR had a negative histologic findings,
while 1 patients diagnosed as acute myocarditis at MR had histological findings suggestive for...
Inflammatory cardiomyopathy is the most frequent diagnosis in patients with this kind of arrhythmic events presentation.
or Delayed Enhanced CT when MR is controindicated,
may help in the management of these patients,
indicating the correct diagnosis and the need of further investigation with endomyocardial biopsy.
(1) Neilan TG et al.
Late gadolinium enhancement among survivors of sudden cardiac arrest.
Jacc Cardiovas Imaging 2015; 8(4):414-23