Author + information
- Giovanni Perettoa,b,
- Simone Salaa,b,
- Alida L.P. Caforioa,b,
- Cristina Bassoa,b,
- Gaetano Thienea,b and
- Paolo Della Bellaa,b
Background: Ventricular arrhythmias (VAs) represent a challenge in patients presenting with structural heart disease and normal coronary arteries. Myocarditis is often a missed underlying etiology and requires endomyocardial biopsy (EMB) for definitive diagnosis.
Methods: We analyzed 65 consecutive patients (46.2±15.1 y; 72% males) presented to emergency room with VAs. All of them had normal coronary angiograms. In order to accurately define etiology and personalize therapy, we performed an intense diagnostic workup including lab exams, trans-thoracic echocardiogram, contrast enhanced cardiac magnetic resonance (CMR) and EMB. In patients with imaging strongly suggesting myocarditis, complete immunologic and infective screening was performed.
Results: All the patients had echo signs of structural heart disease (n=65). In some cases CMR showed edema (STIR+, n=15) or fibrosis (LGE+, n=39). Based on histological data, final diagnosis was myocarditis in 44 patients (67.7%). Overall, EMB results were consistent with CMR in 51/65 patients (78.5%). Significantly, however, even in patients with CMR suggesting myocarditis, precise etiologic diagnosis was defined only by EMB. Of the 26 patients intensively screened, 8 (30.7%) had a diagnosis of viral myocarditis (group V) vs. 18 (69.3%) of autoimmune one (group A). 12/18 group A vs. 1/8 group V patients had chronic myocarditis (p = 0.03). Consistently, extension of fibrosis at CMR resulted significantly greater in group A (52.5±7.3 vs. 45.5±5.1 % of myocardial mass, p = 0.02), where ventricular tachycardia (VT) was more often monomorphic (10/11 vs. 2/6 in group V, p =0.03). In group V, 2/2 patients with monomorphic VT had parvovirus B19 genome on cardiac tissue. No significant differences were found between groups in lab values such as TnT, NT-proBNP, WBC count, CRP and ESR levels (all p=n.s.).
Conclusions: In patients with VAs and non-ischemic heart disease, myocarditis represents the most frequent underlying cause. Even if CMR shows acceptable accuracy, definitive diagnosis is possible only by EMB. Monomorphic VT and greater extension of fibrosis at CMR are more common in autoimmune vs. viral myocarditis.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Fibrillatory Arrhythmias: Outcomes With Contemporary Practice
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1110-099
- 2017 American College of Cardiology Foundation