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.

中文翻译：

---

CMR在正常超声心动图患者中识别室性心律失常的底物。

目的本研究旨在确定在超声心动图检查排除了病理结果的室性心律不齐患者中，心脏磁共振（CMR）是否可以识别结构性心脏病（SHD）。背景技术大约一半的突发性心脏死亡可归因于恶性VA。超声心动图通常用于识别SHD，它是VA的最常见底物。方法对连续的VA值大的患者进行单中心前瞻性研究，其分类为> 1,000但<10,000的心室异位搏动[VEBs] / 24 h。≥10,000VEBs / 24小时；非持续性室性心动过速，持续性室性心动过速或心脏骤停史，超声心动图检查无病理发现，需要临床指征的CMR。主要终点是SMR的CMR检测。次要终点指标是SMR的CMR检测和非明确SHD诊断所特有的异常发现的综合结果。结果共有946例患者入组（平均年龄41±16岁；男性64％）。CMR研究用于241例患者（25.5％）的SHD诊断，而对于187例（19.7％）的明确SHD诊断没有特异性的异常发现。心肌炎（n = 91）是最常见的疾病，其次是心律失常性心肌病（n = 55），扩张型心肌病（n = 39），缺血性心脏病（n = 22），肥厚型心肌病（n = 13），先天性心脏病（n = 10），左心室不紧致（n = 5）和心包炎（n = 5）。CMR图像上SHD的最强单因素和多因素预测指标是胸痛（比值比[OR]：2.52和2.38）和持续性室性心动过速（OR：2）。67和2.23）。结论在大量VA显着且超声心动图完全正常的患者中，可以通过CMR成像确定SHD。胸痛和持续性室性心动过速是CMR成像结果阳性的最强预测指标。