Dabir, Darius

Ferrari, Victor A

Naehle, Claas P

Nickenig, Georg

Schild, Hans

Thomas, Daniel

Weisser-Thomas, Jutta

English

PubMed

Ferrari Victor A

Nickenig Georg

Schild Hans

Dabir Darius

Naehle Claas P

Thomas Daniel

Weisser-Thomas Jutta

Directory of Open Access Journals

Journal of Cardiovascular Magnetic Resonance

Pathological CMR findings and their clinical value in patients with high grade ventricular arrythmias without previously known cardiac conditions

Daniel Thomas

Claas P Naehle

Darius Dabir

Hans Schild

Georg Nickenig

Victor A Ferrari

Jutta Weisser-Thomas

Springer - Publisher Connector

ORAL PRESENTATION Open Access
Pathological CMR findings and their clinical value
in patients with high grade ventricular arrythmias
without previously known cardiac conditions
Daniel Thomas1*, Claas P Naehle1, Darius Dabir1, Hans Schild1, Georg Nickenig1, Victor A Ferrari2,
Jutta Weisser-Thomas1
From 2011 SCMR/Euro CMR Joint Scientific Sessions
Nice, France. 3-6 February 2011
Introduction
Recent studies have demonstrated the ability of CMR
to identify the anatomic correlate of high grade ventri-
cular arrhythmia (VA) in HCM and CHD patients.
However, little is known about the value of CMR in
patients with VAs, without previously known cardiac
conditions.
Purpose
To investigate the value of CMR for detection of under-
lying heart disease and arrhythmogenic substrate in
patients with VAs.
Methods
Patients with VAs, without known cardiac condition
were included (n=71). CMR, echocardiography and
12-lead ECGs were performed in all patients. Most
patients underwent electrophysiologic testing (EPS).
CMR findings were correlated with ECG and/or EPS
findings. A morphological substrate was defined as 1)
underlying cardiac condition detected by CMR, known
to cause associated arrhythmia, or 2) presence of an
electro-anatomic correlate, if the location of a structural
abnormality/scar tissue, matched the origin of the VA as
defined by ECG and/or EPS. A positive CMR finding
was defined as clinically relevant if 1) it resulted in a
new diagnosis, or 2) a change of treatment, or 3) addi-
tional diagnostic procedures.
Results
Pathological CMR findings were found in 42 patients.
The main findings were wall motion abnormalities
(n=22), ventricular hypertrophy (n=10), dilatation (LV
or RV or atrium, total=28), wall thinning (n=3), pericar-
dial and/or pleural effusion (n=6), myocardial scar/struc-
tural abnormalies (n=14).
Based on CMR a diagnosis of heart disease was estab-
lished in 19 patients (27%; DCM n = 3, HCM n = 1, cri-
teria for ARCM n = 2, post-myocarditis scar n = 7,
post-myocardial infarction scar n = 2, myocarditis n =
4). In 15/71 patients (21%) the definite diagnosis was
obtained by CMR exclusively. All CMR based diagnoses
were classified as morphological substrates. In 8 patients
the location of the relevant CMR finding (myocardial
scar) directly matched the origin of the VA as defined
by ECG or EPS. In none of these patients the relevant
finding was detected by echocardiography. The diag-
noses resulted in a change of treatment in 11 patients
(15%) and a change of treatment plus additional diag-
nostic procedures in 8 patients (11%).
Conclusions
This is the first study revealing the value of CMR for detec-
tion of the morphological substrate and/or underlying car-
diac condition in patients with VAs, without any previously
known cardiac disease. The high incidence of clinically
relevant CMR findings raises the question, whether CMR
should routinely be performed in those patients.
Author details
1University of Bonn, Bonn, Germany. 2University of Pennsylvania,
Philadelphia, PA, USA.
1University of Bonn, Bonn, Germany
Full list of author information is available at the end of the article
Thomas et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O42
http://jcmr-online.com/content/13/S1/O42
© 2011 Thomas et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-O42
Cite this article as: Thomas et al.: Pathological CMR findings and their
clinical value in patients with high grade ventricular arrythmias without
previously known cardiac conditions. Journal of Cardiovascular Magnetic
Resonance 2011 13(Suppl 1):O42.
Submit your next manuscript to BioMed Central
and take full advantage of: 
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at 
www.biomedcentral.com/submit
Thomas et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O42
http://jcmr-online.com/content/13/S1/O42
Page 2 of 2


Crossref

ORAL PRESENTATION Open AccessPathological CMR findings and their clinical valuein patients with high grade ventricular arrythmiaswithout previously known cardiac conditionsDaniel Thomas1*, Claas P Naehle1, Darius Dabir1, Hans Schild1, Georg Nickenig1, Victor A Ferrari2,Jutta Weisser-Thomas1From 2011 SCMR/Euro CMR Joint Scientific SessionsNice, France. 3-6 February 2011IntroductionRecent studies have demonstrated the ability of CMRto identify the anatomic correlate of high grade ventri-cular arrhythmia (VA) in HCM and CHD patients.However, little is known about the value of CMR inpatients with VAs, without previously known cardiacconditions.PurposeTo investigate the value of CMR for detection of under-lying heart disease and arrhythmogenic substrate inpatients with VAs.MethodsPatients with VAs, without known cardiac conditionwere included (n=71). CMR, echocardiography and12-lead ECGs were performed in all patients. Mostpatients underwent electrophysiologic testing (EPS).CMR findings were correlated with ECG and/or EPSfindings. A morphological substrate was defined as 1)underlying cardiac condition detected by CMR, knownto cause associated arrhythmia, or 2) presence of anelectro-anatomic correlate, if the location of a structuralabnormality/scar tissue, matched the origin of the VA asdefined by ECG and/or EPS. A positive CMR findingwas defined as clinically relevant if 1) it resulted in anew diagnosis, or 2) a change of treatment, or 3) addi-tional diagnostic procedures.ResultsPathological CMR findings were found in 42 patients.The main findings were wall motion abnormalities(n=22), ventricular hypertrophy (n=10), dilatation (LVor RV or atrium, total=28), wall thinning (n=3), pericar-dial and/or pleural effusion (n=6), myocardial scar/struc-tural abnormalies (n=14).Based on CMR a diagnosis of heart disease was estab-lished in 19 patients (27%; DCM n = 3, HCM n = 1, cri-teria for ARCM n = 2, post-myocarditis scar n = 7,post-myocardial infarction scar n = 2, myocarditis n =4). In 15/71 patients (21%) the definite diagnosis wasobtained by CMR exclusively. All CMR based diagnoseswere classified as morphological substrates. In 8 patientsthe location of the relevant CMR finding (myocardialscar) directly matched the origin of the VA as definedby ECG or EPS. In none of these patients the relevantfinding was detected by echocardiography. The diag-noses resulted in a change of treatment in 11 patients(15%) and a change of treatment plus additional diag-nostic procedures in 8 patients (11%).ConclusionsThis is the first study revealing the value of CMR for detec-tion of the morphological substrate and/or underlying car-diac condition in patients with VAs, without any previouslyknown cardiac disease. The high incidence of clinicallyrelevant CMR findings raises the question, whether CMRshould routinely be performed in those patients.Author details1University of Bonn, Bonn, Germany. 2University of Pennsylvania,Philadelphia, PA, USA.1University of Bonn, Bonn, GermanyFull list of author information is available at the end of the articleThomas et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O42http://jcmr-online.com/content/13/S1/O42© 2011 Thomas et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.Published: 2 February 2011doi:10.1186/1532-429X-13-S1-O42Cite this article as: Thomas et al.: Pathological CMR findings and theirclinical value in patients with high grade ventricular arrythmias withoutpreviously known cardiac conditions. Journal of Cardiovascular MagneticResonance 2011 13(Suppl 1):O42.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitThomas et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):O42http://jcmr-online.com/content/13/S1/O42Page 2 of 2

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Pathological CMR findings and their clinical value in patients with high grade ventricular arrythmias without previously known cardiac conditions

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