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Article

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

by
George Markousis-Mavrogenis
1,
George Poulos
1,
Theodoros Dimitroulas
2,
Aikaterini Giannakopoulou
3,
Clio Mavragani
4,5,
Vasiliki Vartela
1,
Dionysia Manolopoulou
1,
Genovefa Kolovou
1,
Paraskevi Voulgari
6,
Petros P. Sfikakis
5,7,
George D. Kitas
8,9 and
Sophie I. Mavrogeni
1,5,*
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
*
Author to whom correspondence should be addressed.
Diagnostics 2021, 11(3), 519; https://doi.org/10.3390/diagnostics11030519
Submission received: 29 December 2020 / Revised: 16 February 2021 / Accepted: 12 March 2021 / Published: 15 March 2021
(This article belongs to the Special Issue Imaging Cardiac Arrhythmia/Sudden Cardiac Death)
Versions Notes

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

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MDPI and ACS Style

Markousis-Mavrogenis, G.; Poulos, G.; Dimitroulas, T.; Giannakopoulou, A.; Mavragani, C.; Vartela, V.; Manolopoulou, D.; Kolovou, G.; Voulgari, P.; Sfikakis, P.P.; et al. Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction. Diagnostics 2021, 11, 519. https://doi.org/10.3390/diagnostics11030519

AMA Style

Markousis-Mavrogenis G, Poulos G, Dimitroulas T, Giannakopoulou A, Mavragani C, Vartela V, Manolopoulou D, Kolovou G, Voulgari P, Sfikakis PP, et al. Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction. Diagnostics. 2021; 11(3):519. https://doi.org/10.3390/diagnostics11030519

Chicago/Turabian Style

Markousis-Mavrogenis, George, George Poulos, Theodoros Dimitroulas, Aikaterini Giannakopoulou, Clio Mavragani, Vasiliki Vartela, Dionysia Manolopoulou, Genovefa Kolovou, Paraskevi Voulgari, Petros P. Sfikakis, and et al. 2021. "Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction" Diagnostics 11, no. 3: 519. https://doi.org/10.3390/diagnostics11030519

APA Style

Markousis-Mavrogenis, G., Poulos, G., Dimitroulas, T., Giannakopoulou, A., Mavragani, C., Vartela, V., Manolopoulou, D., Kolovou, G., Voulgari, P., Sfikakis, P. P., Kitas, G. D., & Mavrogeni, S. I. (2021). Ventricular Tachycardia Has Mainly Non-Ischaemic Substrates in Patients with Autoimmune Rheumatic Diseases and a Preserved Ejection Fraction. Diagnostics, 11(3), 519. https://doi.org/10.3390/diagnostics11030519

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