Cardiac Magnetic Resonance in the Evaluation of Patients With Frequent Premature Ventricular Complexes

BACKGROUND The role of cardiac magnetic resonance (CMR) in the evaluation and management of patients with frequent premature ventricular complexes (PVCs) of unknown etiology remains unclear. OBJECTIVES This study evaluated the prevalence and prognostic significance of myocardial abnormalities detected with CMR among patients with frequent PVCs and no known structural heart disease. METHODS This prospective cohort study included consecutive patients with frequent PVCs and a negative initial diagnostic work-up who underwent CMR with late gadolinium enhancement imaging. The clinical outcome was a com-posite of mortality, ventricular fibrillation, sustained ventricular tachycardia, or reduction in left ventricular ejection fraction of >= 10%. RESULTS A total of 255 patients were included, of whom 35 (13.7%) had evidence of myocardial abnormality on CMR. Age & GE;60 years (odds ratio [OR]: 6.96; 95% CI: 1.30-37.18), multifocal PVCs (OR: 10.90; 95% CI: 3.21-36.97), and non -outflow tract left ventricular PVC origin (OR: 3.00; 95% CI: 1.00-8.95) were independently associated with the presence of a myocardial abnormality on CMR. After a median follow-up of 36 months, the composite outcome occurred in 15 (5.9%) patients. The presence of a myocardial abnormality on CMR was independently associated with the composite outcome (HR: 4.35; 95% CI: 1.34-14.15; P 1/4 0.014). CONCLUSIONS One in 7 patients with frequent PVCs with no known structural heart disease had myocardial abnor-mality detected on CMR, and these abnormalities were associated with adverse clinical outcomes. These findings highlight the important role of CMR in the evaluation of patients with frequent PVCs. (J Am Coll Cardiol EP 2022;8:1122-1132) (C) 2022 by the American College of Cardiology Foundation.