Premature Ventricular Contractions in Diabetic Patients: What Can We Learn from Cardiac Magnetic Resonance?

Background: We have previously showed, within a non-selected cohort of patients referred for premature ventricular contractions (PVCs) that cardiac magnetic resonance (CMR) detects structural abnormalities in 48% of cases with diabetes identified as a predictor of such abnormalities (1). This study aims to further investigate the diagnostic value of CMR specifically in diabetic patients.

Methods: The study compared 25 diabetic patients (Group 1) with 175 non-diabetic patients (Group 2), all referred by cardiologists following an initial evaluation that included ECG, echocardiography and treadmill exercise ECG testing. CMR imaging was performed using 1.5 and 3 Tesla scanner with a standardized protocol. The performance of CMR was assessed based on its ability to identify structural abnormalities not previously detected during the initial workup.

Results: Group 1 patients were significantly older, exhibited a higher prevalence of cardiovascular risk factor, a greater frequency of PVCs that increase with exercise as well as non-sustained ventricular tachycardia (VT) compared to Group 2 (Table1).

CMR revealed a significant higher incidence of structural abnormalities in Group 1 (21 patients (84%) vs 71 patients (41%) p < 0.001) primarily characterized by non-ischemic fibrosis (48% vs 23%) followed by ischemic fibrosis (16% vs 7.4%) and mixed fibrosis (12% vs 1.1%). Wall motion abnormalities were also more prevalent in Group 1 (36% vs 10%, p=0.002). After adjusting for cardiovascular risk factors using a propensity score, multivariate analysis confirmed that diabetes is significantly and independently associated to CMR-detected structural abnormalities (OR 2.04 95% CI 1.18-3.57 p = 0.011) alongside PVCs that increase with exercise, pleomorphic PVCs and non-sustained VT (Table2).

Conclusion: This preliminary study underscores the critical role of CMR in diabetic patients presenting with PVCs, revealing structural abnormalities in a substantial majority (84%), primarily non-ischemic fibrosis despite the presence of traditional cardiovascular risk factor. These findings suggest that diabetes may contribute to the development of myocardial fibrosis and could be strongly considered in diabetic patients with PVCs. Larger-scale studies are warranted to further elucidate these associations and optimize clinical management strategies

Baseline characteristics in diabetic patients ( Group 1) compared to non diabetic patients ( Group 2)

Characteristics	Overall Nf200 </span>	Group 1 Nf25</span>	Group 2 Nf175</span>	P-value¹
Age (years) ± SD	59 (15)	67 (9)	58(15)	<0.001
Male gender (%)	129 (65)	20 (80)	109 (62)	0.083
Body mass index  ( kg/m²)	26.7 (4.8)	29.2 (4.9)	26.3 (4.7)	0.009
Hyperlipidemia (%)	47 (24)	18 (72)	29 (17)	<0.001
Hypertension (%)	83 (42)	19 (76)	64 (37)	<0.001
PVCs increasing with exercise (%)	67 (34)	13 (52)	54 (31)	0.036
Non sustained VT	64 (32)	14 (56)	50 (29)	0.006
¹ Welch Two Sample t-test; Pearson's Chi-squared test; Fisher's exact test

 Significant factors associated to CMR-detected structural abnormalies

 

 

Characteristics	Multivariate analysis (adjusted odds ratio, 95% CI, p-value)
Diabetes	2.04 (1.18-3.57) P=0.011
PVCs increasing with exercise	5.13 (2.78-9.77) p<0.001
Pleomorphic PVCs	2.30 (1.02-5.39) P=0.049
Non-sustained VT	6.47 (3.74-11.5) P<0.001