Diagnostic yield of cardiovascular magnetic resonance in young-middle aged patients with high-grade atrio-ventricular block. (1st October 2017)

• Record Type: Journal Article
• Authors: Baritussio, A.; Ghosh Dastidar, A.; Frontera, A.; Ahmed, N.; De Garate, E.; Harries, I.; Diab, I.; Duncan, E.; Thomas, G.; Nisbet, A.; Bucciarelli-Ducci, C.
• Is Part Of: International journal of cardiology. Volume 244(2017)
• Page Start: 335
• Page End: 339
• Publication Date: 2017-10-01
• Subjects: AVB Atrio-ventricular block -- CMR Cardiovascular magnetic resonance -- ECG Electrocardiogram -- IHD Ischemic heart disease -- LGE Late gadolinium enhancement -- LMNA Lamin A/C -- LV Left ventricle -- NIHD Non-ischemic heart disease -- PM Pace-maker -- RV Right ventricle -- TAVI Trans-catheter aortic valve implantation -- TTE Transthoracic echocardiogram; High grade atrio-ventricular block -- Cardiovascular magnetic resonance -- Myocardial tissue characterization; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.06.080
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Atrio-ventricular block (AVB) is a rare finding in young or middle-aged adults, often leading to pacemaker implantation (PM) without further investigation. We sought to assess the diagnostic role of cardiovascular magnetic resonance (CMR) in young and middle-aged adults with high-grade AVB. Methods: We consecutively enrolled young-middle aged (18–65 years) patients with high grade AVB referred to CMR after standard clinical assessment (history, electrocardiogram and cardiac rhythm monitoring) prior to PM implantation. Cine and post-contrast imaging were performed in a 1.5T scanner. Results: 34 patients (59% male, mean age 42 ± 12 years) with high grade AVB were referred to CMR for suspected ischemic heart disease (IHD)(n = 4) and non-ischemic heart disease (NIHD)(n = 20); no clear cause was found in 9 patients prior to CMR and 1 patient had suspected lung disease. A pathologic substrate was found on CMR in 15 patients (44%), while a structurally normal heart was reported in 18 (53%). Non-specific findings were reported in 1 patient (3%). There was a fair agreement between CMR and echocardiographic findings (Cohen's kappa 0.243), and CMR provided an entirely new diagnosis in 34% of patients. As compared to the standard clinical assessment, CMR had an additional role in 65% of patients and guided further testing (genetic testing, extra-cardiac imaging) in 9%. Conclusions: CMR found a pathologic substrate in 44% of patients, mainly NIHD (32%). Half of the patients (53%) had a structurally normal heart. When added to the standard clinical assessment, CMR had an incremental diagnostic role in two thirds of patients.