CMR for Identifying the Substrate of Ventricular Arrhythmia in Patients With Normal Echocardiography

Daniele Andreini, Antonio Dello Russo, Gianluca Pontone, Saima Mushtaq, Edoardo Conte, Marco Perchinunno, Marco Guglielmo, Ana Coutinho Santos, Marco Magatelli, Andrea Baggiano, Simone Zanchi, Eleonora Melotti, Laura Fusini, Paola Gripari, Michela Casella, Corrado Carbucicchio, Stefania Riva, Gaetano Fassini, Letizia Li Piani, Cesare FiorentiniAntonio L. Bartorelli, Claudio Tondo, Mauro Pepi

Research output: Contribution to journalArticlepeer-review


Objectives: 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. Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)410-421
Number of pages12
JournalJACC: Cardiovascular Imaging
Issue number2
Publication statusPublished - Feb 2020


  • additional diagnostic value
  • arrhythmic substrate
  • cardiac magnetic resonance
  • cardiomyopathy
  • late gadolinium enhancement
  • myocarditis
  • prognosis
  • ventricular arrhythmia

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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