Role of Cardiac Magnetic Resonance Imaging in the Evaluation of Athletes with Premature Ventricular Beats

Abstract

Premature ventricular beats (PVBs) in athletes are not rare. The risk of PVBs depends on the presence of an underlying pathological myocardial substrate predisposing the subject to sudden cardiac death. The standard diagnostic work-up of athletes with PVBs includes an examination of family and personal history, resting electrocardiogram (ECG), 24 h ambulatory ECG (possibly with a 12-lead configuration and including a training session), maximal exercise testing and echocardiography. Despite its fundamental role in the diagnostic assessment of athletes with PVBs, echocardiography has very limited sensitivity in detecting the presence of non-ischemic left ventricular scars, which can be revealed only through more in-depth studies, particularly with the use of contrast-enhanced cardiac magnetic resonance (CMR) imaging. The morphology, complexity and exercise inducibility of PVBs can help estimate the probability of an underlying heart disease. Based on these features, CMR imaging may be indicated even when echocardiography is normal. This review focuses on interpreting PVBs, and on the indication and role of CMR imaging in the diagnostic evaluation of athletes, with a special focus on non-ischemic left ventricular scars that are an emerging substrate of cardiac arrest during sport.

WITHDRAWN: Sudden death of an athlete due to concealed arrhythmogenic cardiomyopathy: Why preparticipation screening did fail

“…Modern interpretation of PVBs in athletes mostly relies on morphology of the ectopic QRS complex and behaviour during exercise testing rather than on PVBs count (Table 2) [17]. Ventricular arrhythmias with RBBB pattern (suggesting left ventricular origin) or multiple morphologies (polymorphous) that appear only during exercise are at highest risk of an underlying concealed myocardial substrate and should lead to CMR prescription, even if echocardiography is normal [18].…”

Evolving spectrum of arrhythmogenic cardiomyopathy: Implications for Sports Cardiology

“…PVBs or VT with LBBB/superior axis morphology are more specific for ACM as they originate from the RV free wall or interventricular septum. Instead, VAs with a LBBB/inferior axis morphology are less specific (minor criterion), and are often idiopathic, in keeping with an origin from RV outflow tract, but they should still be investigated at least by echocardiography 37,38 . The traditional idea is that the risk of an underlying disease correlates with number of PVBs, and the International recommendations classify as abnormal the recording of at least two PVBs on a single ECG tracking in athletes 36 .…”

“…VAs features, CMR should be prescribed to athletes to rule out ALVC or other forms of nonischemic myocardial scarring even when echocardiography and ECG are normal. 37,38 5 | MANAGEMENT OF ATHLETES WITH ACM (1) promote the development of disease in subjects with positive genotype and negative phenotype 13 ; (2) worsen the degree of RV dysfunction in subjects with overt disease; (3) facilitate VAs (including appropriate ICD interventions 49 ). Indeed, intense physical practice seems to be associated with a fivefold increase in the risk of SCD when compared to sedentary patients.…”

May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review

“…Increased signal in the correspondent areas of fibrosis in the native T1 mapping short-axis sequence ( D ). Reproduced with permission from Brunetti et al [ 129 ].…”