Diagnostic Value of Cardiac Magnetic Resonance in Patients with Frequent Ventricular Arrhythmia and Normal Doppler Echocardiography

La arritmia ventricular frecuente (AVF) puede ser una alteración eléctrica primaria, o estar asociada a una cardiopatía. El impacto pronóstico y terapéutico depende  de la presencia de cardiopatía estructural. . El ecocardiograma doppler transtorácico ha sido el estudio complementario más importante para evaluar la presencia de alteraciones estructurales cardíacas. El objetivo de nuestro estudio consiste en determinar la capacidad de la resonancia magnética cardíaca (RMC) para detectar alteraciones estructurales a nivel cardíaco en pacientes con ecocardiograma doppler normal y conocer la incidencia de eventos cardiovasculares adversos en el seguimiento. Se incluyeron 66 pacientes consecutivos con arritmia ventricular frecuente definido como extrasístoles ventriculares > 5000 en un registro de Holter de 24 hs, taquicardia ventricular o muerte súbita resucitada con ecocardiograma doppler normal. A todos los pacientes se les realizó una resonancia magnética cardíaca con protocolo para evaluar miocardiopatías. El 57% de los pacientes presentó alguna alteración estructural, siendo las patologías diagnosticadas más prevalente: la secuela de miocarditis, el miocardio no compactado y la secuela de infarto subendocárdico.  En el seguimiento medio de  24 ± 22 meses, la incidencia de eventos cardiovasculares adversos fue 6.06%. El número de extrasístoles ventriculares fue mayor en aquellos pacientes con resonancia anormal. Este trabajo demuestra que en pacientes con arritmia ventricular frecuente con ecocardiograma doppler normal, la realización de una resonancia magnética cardíaca con gadolinio permite detectar en más de la mitad de los casos alguna alteración estructural.IntroductionFrequent ventricular arrhythmia can be a primary electrical disturbance or may beassociated to cardiomyopathy. The prognostic and therapeutic impact depends onthe presence of structural heart disease. Transthoracic Doppler echocardiographyhas been the most important complementary study to evaluate the presence of cardiacstructural abnormalities.ObjectivesThe aims of this study were to determine the ability of cardiac magnetic resonanceimaging to detect structural heart disease in patients with normal Doppler echocardiogramand to assess the incidence of adverse cardiovascular events during followup.MethodsThe study included 66 consecutive patients with frequent ventricular arrhythmiadefined as > 5000 ventricular extrasystoles in 24-hour Holter monitoring, ventriculartachycardia or resuscitated cardiac respiratory arrest with normal Dopplerechocardiogram. All patients underwent cardiac magnetic resonance imaging to assesscardiomyopathies.ResultsFifty-seven percent of patients had structural heart disease. The most prevalentdiagnosed pathologies were myocarditis sequelae, non-compacted myocardium andsubendocardial infarction scar. At mean follow-up of 24 ± 22 months, the incidenceof adverse cardiovascular events was 6.06 %. The number of ventricular extrasystoleswas higher in patients with abnormal cardiac magnetic resonance.DiscussionThis work demonstrates that in patients with frequent ventricular arrhythmia andnormal Doppler echocardiogram, gadolinium cardiac magnetic resonance imagingcan detect structural heart disease in more than half of the cases. Patients with frequentventricular arrhythmia during Holter monitoring, normal Doppler echocardiogramand mild alterations in the magnetic resonance present low risk of cardiovascularevents

Eur J Cancer

BACKGROUND: To define a core set of geriatric data to be methodically collected in clinical cancer trials of older adults, enabling comparison across trials. PATIENTS AND METHODS: Following a consensus approach, a panel of 14 geriatricians from oncology clinics identified seven domains of importance in geriatric assessment. Based on the international recommendations, geriatricians selected the mostly commonly used tools/items for geriatric assessment by domain (January-October 2015). The Geriatric Core Dataset (G-CODE) was progressively developed according to RAND appropriateness ratings and feedback during three successive Delphi rounds (July-September 2016). The face validity of the G-CODE was assessed with two large panels of health professionals (55 national and 42 international experts) involved both in clinical practice and cancer trials (March-September 2017). RESULTS AND DISCUSSION: After the last Delphi round, the tools/items proposed for the G-CODE were the following: (1) social assessment: living alone or support requested to stay at home; (2) functional autonomy: Activities of Daily Living (ADL) questionnaire and short instrumental ADL questionnaire; (3) mobility: Timed Up and Go test; (4) nutrition: weight loss during the past 6 months and body mass index; (5) cognition: Mini-Cog test; (6) mood: mini-Geriatric Depression Scale and (7) comorbidity: updated Charlson Comorbidity Index. More than 70% of national experts (42 from 20 cities) and international experts (31 from 13 countries) participated. National and international surveys showed good acceptability of the G-CODE. Specific points discussed included age-year cut-off, threshold of each tool/item and information about social support, but no additional item was proposed. CONCLUSION: We achieved formal consensus on a set of geriatric data to be collected in cancer trials of older patients. The dissemination and prospective use of the G-CODE is needed to assess its utility