What is the Diagnostic Utility of Cardiac Magnetic Resonance Imaging in Unselected Patients with Premature Ventricular Contractions and Non-Sustained Ventricular Tachycardia?

Abstract

Purpose: Premature ventricular contractions (PVCs) and non-sustained ventricular tachycardia (NSVT) are common arrhythmias that may signal underlying structural heart disease (SHD). Cardiac magnetic resonance imaging (CMR) has emerged as a valuable tool for detecting myocardial abnormalities in this population. This study aimed to evaluate the diagnostic utility of CMR in patients with PVCs/NSVT and identify clinical predictors of pathologic late gadolinium enhancement (LGE).

Methods: We retrospectively reviewed patients who underwent CMR for PVCs or NSVT between 2012 and 2023 at a single health system. The primary outcome was the presence of pathologic LGE. Clinical data were extracted using ICD-10 codes, and cardiac sarcoidosis (CS) was adjudicated by a multidisciplinary team using WASOG criteria.

Results: Among 553 patients (mean age 61.1 ± 14.6 years; 40.7% female), pathologic LGE was identified in 214 (38.6%). Patients with LGE were older and had a greater burden of comorbidities. On multivariable analysis, independent risk factors for LGE included age (aOR 1.04, p=0.001), male sex (aOR 2.37, p<0.001), heart failure (aOR 2.53, p<0.001), and polymorphic PVCs (aOR 1.94, p=0.015). Among patients with LGE, 12.6% had highly probable CS. Other diagnoses included non-ischemic cardiomyopathy (53.7%), ischemic cardiomyopathy (11.7%), and idiopathic (34.6%).

Conclusion: CMR frequently detects clinically significant myocardial abnormalities in patients with PVCs or NSVT, particularly in those with high-risk features. In this real-world study, nearly 40% of patients had LGE on CMR. An etiology was identified in one-third of these cases. These findings can inform patient selection for CMR in clinical practice to guide diagnosis, risk stratification, and management.