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Arrhythmias and sudden death
Systematic review
Cardiac magnetic resonance for ventricular arrhythmias: a systematic review and meta-analysis
  1. Christos A Papanastasiou1,2,
  2. Maria-Anna Bazmpani1,
  3. Polydoros N Kampaktsis3,
  4. Thomas Zegkos1,
  5. Thomas Gossios1,
  6. Despoina Parcharidou1,
  7. Damianos G Kokkinidis4,
  8. Ioannis Tziatzios2,
  9. Fotios I Economou2,
  10. Chrysovalantou Nikolaidou5,
  11. Vasileios Kamperidis1,
  12. Apostolos Tsapas6,7,
  13. Antonios Ziakas1,
  14. Georgios Efthimiadis1,
  15. Theodoros D Karamitsos1
  1. 1 1st Cardiology Department, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece
  2. 2 Cardiology Department, 424 General Military Training Hospital, Thessaloniki, Greece
  3. 3 Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York City, New York, USA
  4. 4 Heart and Vascular Institute, L&M, Yale New Haven Health, New Haven, Connecticut, USA
  5. 5 Gloucestershire Health and Care NHS Foundation Trust, Brockworth, Gloucestershire, UK
  6. 6 Center for Clinical Research and Evidence-Based Medicine, Aristotle University Thessaloniki, Thessaloniki, Greece
  7. 7 Harris Manchester College, University of Oxford, Oxford, UK
  1. Correspondence to Professor Theodoros D Karamitsos; tkaramitsos{at}auth.gr

Abstract

Background Cardiac magnetic resonance (CMR) allows comprehensive myocardial tissue characterisation, revealing areas of myocardial inflammation or fibrosis that may predispose to ventricular arrhythmias (VAs). With this study, we aimed to estimate the prevalence of structural heart disease (SHD) and decipher the prognostic implications of CMR in selected patients presenting with significant VAs.

Methods Electronic databases were searched for studies enrolling adult patients that underwent CMR for diagnostic or prognostic purposes in the setting of significant VAs. A random effects model meta-analysis of proportions was performed to estimate the prevalence of SHD. HRs were pooled together in order to evaluate the prognostic value of CMR.

Results The prevalence of SHD was reported in 18 studies. In all-comers with significant VAs, the pooled rate of SHD post-CMR evaluation was 39% (24% in the subgroup of premature ventricular contractions and/or non-sustained ventricular tachycardia vs 63% in the subgroup of more complex VAs). A change in diagnosis after use of CMR ranged from 21% to 66% with a pooled average of 35% (29%–41%). A non-ischaemic cardiomyopathy was the most frequently identified SHD (56%), followed by ischaemic heart disease (21%) and hypertrophic cardiomyopathy (5%). After pooling together data from six studies, we found that the presence of late gadolinium enhancement was associated with increased risk of major adverse outcomes in patients with significant VAs (pooled HR: 1.79; 95% CI 1.33 to 2.42).

Conclusion CMR is a valuable tool in the diagnostic and prognostic evaluation of patients with VAs. CMR should be considered early after initial evaluation in the diagnostic algorithm for VAs of unclear aetiology as this strategy may also define prognosis and improve risk stratification.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/heartjnl-2024-324182

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors Conception: CP, TK. Design: CP, PK, M-AB, TK. Electronic search: CP, M-AB. Data extraction: DGK, IT. Statistical analysis: CP, DGK, TZ. Risk of bias: CP, DP. Writing: CP, PK, M-AB, TK. Editing/final review: all authors. Guarantor: TK.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer-reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.