TY - JOUR
T1 - Noninvasive diagnosis of electroanatomic abnormalities in arrhythmogenic right ventricular cardiomyopathy
AU - Santangeli, Pasquale
AU - Pieroni, Maurizio
AU - Dello Russo, Antonio
AU - Casella, Michela
AU - Pelargonio, Gemma
AU - Macchione, Andrea
AU - Camporeale, Antonia
AU - Smaldone, Costantino
AU - Bartoletti, Stefano
AU - Di Biase, Luigi
AU - Bellocci, Fulvio
AU - Natale, Andrea
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2010/12
Y1 - 2010/12
N2 - Background-The diagnostic reliability and pathophysiologic relevance of different noninvasive diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are undefined. We tested the association between noninvasive diagnostic criteria for ARVC and the presence of low-voltage areas (LVAs) detected at electroanatomic voltage mapping (EAM). Methods and Results-Noninvasive diagnostic criteria, including ECG, signal-averaged ECG (SAECG), and cardiac magnetic resonance (CMR) criteria, were compared with the presence and location of LVAs detected at right ventricular (RV) EAM in 17 patients (9 men) aged 50±16 years with biopsy specimen-proven ARVC. LVAs were found in 15 (88%) patients. Patients with surface ECG abnormalities showed a higher degree of RV involvement than those without ECG abnormalities (number of LVAs, 1.8±0.5 versus 0.9±0.6, respectively; P<0.01). A significant association was found between SAECG abnormalities and LVAs in the RV outflow tract (P=0.03) but not between SAECG parameters and LVAs in other RV regions. Among CMR findings, RV delayed enhancement was more significantly associated with the distribution of LVAs (free wall, P<0.01; outflow tract, P<0.01; posteroinferior wall, P=0.02). Regional RV dysfunction also showed a good correlation with LVAs, with the most significant association being found with the free wall (P=0.01), whereas RV fat infiltration at CMR was not correlated with LVAs. Conclusion-In patients with ARVC, SAECG abnormalities correlate with the presence of LVAs selectively in the RV outflow tract, whereas surface ECG abnormalities are associated with a more diffuse RV involvement. Myocardial delayed enhancement is the CMR finding more strongly associated with LVAs, thus supporting the appropriateness of its inclusion among diagnostic criteria for ARVC.
AB - Background-The diagnostic reliability and pathophysiologic relevance of different noninvasive diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are undefined. We tested the association between noninvasive diagnostic criteria for ARVC and the presence of low-voltage areas (LVAs) detected at electroanatomic voltage mapping (EAM). Methods and Results-Noninvasive diagnostic criteria, including ECG, signal-averaged ECG (SAECG), and cardiac magnetic resonance (CMR) criteria, were compared with the presence and location of LVAs detected at right ventricular (RV) EAM in 17 patients (9 men) aged 50±16 years with biopsy specimen-proven ARVC. LVAs were found in 15 (88%) patients. Patients with surface ECG abnormalities showed a higher degree of RV involvement than those without ECG abnormalities (number of LVAs, 1.8±0.5 versus 0.9±0.6, respectively; P<0.01). A significant association was found between SAECG abnormalities and LVAs in the RV outflow tract (P=0.03) but not between SAECG parameters and LVAs in other RV regions. Among CMR findings, RV delayed enhancement was more significantly associated with the distribution of LVAs (free wall, P<0.01; outflow tract, P<0.01; posteroinferior wall, P=0.02). Regional RV dysfunction also showed a good correlation with LVAs, with the most significant association being found with the free wall (P=0.01), whereas RV fat infiltration at CMR was not correlated with LVAs. Conclusion-In patients with ARVC, SAECG abnormalities correlate with the presence of LVAs selectively in the RV outflow tract, whereas surface ECG abnormalities are associated with a more diffuse RV involvement. Myocardial delayed enhancement is the CMR finding more strongly associated with LVAs, thus supporting the appropriateness of its inclusion among diagnostic criteria for ARVC.
KW - Arrhythmogenic right ventricular dysplasia
KW - Diagnosis
KW - Electrocardiography
KW - Magnetic resonance
KW - Mapping
UR - http://www.scopus.com/inward/record.url?scp=79952118731&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79952118731&partnerID=8YFLogxK
U2 - 10.1161/CIRCEP.110.958116
DO - 10.1161/CIRCEP.110.958116
M3 - Article
C2 - 20937720
AN - SCOPUS:79952118731
SN - 1941-3149
VL - 3
SP - 632
EP - 638
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 6
ER -