Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction

George Markousis-Mavrogenis; George Poulos; Theodoros Dimitroulas; Aikaterini Giannakopoulou; Clio Mavragani; Vasiliki Vartela; Dionysia Manolopoulou; Genovefa Kolovou; Paraskevi Voulgari; Petros P Sfikakis; George D Kitas; Sophie I Mavrogeni

doi:10.3390/diagnostics11030519

Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction

Diagnostics (Basel). 2021 Mar 15;11(3):519. doi: 10.3390/diagnostics11030519.

Authors

Affiliations

¹ Onassis Cardiac Surgery Center, 17674 Athens, Greece.
² Department of Internal Medicine, Rheumatology, Aristotle University, 54124 Thessaloniki, Greece.
³ Department of Paediatric Cardiology, Agia Sofia Children Hospital, 11527 Athens, Greece.
⁴ Pathophysiology Department, Laikon Hospital, 11527 Athens, Greece.
⁵ First Department of Propaedeutic Internal Medicine and Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece.
⁶ Rheumatology Clinic, University of Ioannina, 45110 Ioannina, Greece.
⁷ First Department of Propeudeutic and Internal Medicine, Laikon Hospital, 11527 Athens, Greece.
⁸ Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK.
⁹ School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK.

Abstract

Non-sustained ventricular tachycardia (NSVT) is a potentially lethal arrhythmia that is most commonly attributed to coronary artery disease. We hypothesised that among patients with NSVT and preserved ejection fraction, cardiovascular magnetic resonance (CMR) would identify a different proportion of ischaemic/non-ischaemic arrhythmogenic substrates in those with and without autoimmune rheumatic diseases (ARDs). In total, 80 consecutive patients (40 with ARDs, 40 with non-ARD-related cardiac pathology) with NSVT in the past 15 days and preserved left ventricular ejection fraction were examined using a 1.5-T system. Evaluated parameters included biventricular volumes/ejection fractions, T2 signal ratio, early/late gadolinium enhancement (EGE/LGE), T1 and T2 mapping and extracellular volume fraction (ECV). Mean age did not differ across groups, but patients with ARDs were more often women (32 (80%) vs. 15 (38%), p < 0.001). Biventricular systolic function, T2 signal ratio and EGE and LGE extent did not differ significantly between groups. Patients with ARDs had significantly higher median native T1 mapping (1078.5 (1049.0-1149.0) vs. 1041.5 (1014.0-1079.5), p = 0.003), higher ECV (31.0 (29.0-32.0) vs. 28.0 (26.5-30.0), p = 0.003) and higher T2 mapping (57.5 (54.0-61.0) vs. 52.0 (48.0-55.5), p = 0.001). In patients with ARDs, the distribution of cardiac fibrosis followed a predominantly non-ischaemic pattern, with ischaemic patterns being more common in those without ARDs (p < 0.001). After accounting for age and cardiovascular comorbidities, most findings remained unaffected, while only tissue characterisation indices remained significant after additionally correcting for sex. Patients with ARDs had a predominantly non-ischaemic myocardial scar pattern and showed evidence of diffuse inflammatory/ischaemic changes (elevated native T1-/T2-mapping and ECV values) independent of confounding factors.

Keywords: cardiovascular magnetic resonance; fibrosis; ischaemia; myocarditis; oedema; rhythm disturbance; sudden cardiac death.