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Allwood RP. A right ventricular bulge: A clinical dilemma in diagnosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39301764 DOI: 10.1002/jcu.23848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/08/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease characterized by progressive fibrofatty tissue replacement of the myocardium. Asymptomatic individuals can often present for the first time with acute cardiac symptoms, such as syncope and ventricular arrhythmias or sudden cardiac death (SCD), which can occur in young and athletic populations. In the field of inherited cardiomyopathies, ARVC is one of the most challenging to diagnose due to its variable expressivity, incomplete penetrance, and lack of specific, unique diagnostic criteria. Without additional clinical findings or context, current imaging modalities are unable to definitively distinguish ARVC from other disease entities. Right ventricular (RV) structural changes can lead to prominent ARVC features. An important component of the 2010 revised task force criteria (TFC) is the assessment of RV wall motion contraction by echocardiography; however, this can be difficult to assess. This case report explores the diagnostic criteria used for ARVC and the role of RV wall motion contraction in the diagnosis.
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Affiliation(s)
- Richard P Allwood
- Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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2
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Allwood RP. Apicolateral bulge: A potential mimic of arrhythmogenic right ventricular cardiomyopathy in a professional athlete-A case report and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39021260 DOI: 10.1002/jcu.23761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
Soccer is the most popular sport in the world, with over 265 million active players and approximately 0.05% professional players worldwide. The Fédération Internationale de Football Association (FIFA) has made preparticipation screening recommendations which involve electrocardiography and echocardiography being performed prior to international competition. The aim of preparticipation cardiovascular screening in young athletes is to detect asymptomatic individuals with cardiovascular disease at risk of sudden cardiac death (SCD). The incidence of SCD in young athletes (age≤ 35 years) is 0.6-3.6 in 100,000 persons/year, with most deaths due to cardiovascular causes. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is one of the leading causes of SCD in young athletes. It is a genetic disease characterized by progressive fibrofatty replacement of the myocardium with variable phenotypic expression. Exercise-induced cardiac remodeling in conjunction with extensive T-wave inversion raises concern for ARVC. This case report and literature review explores a potential mimic for ARVC, the role of cardiovascular screening in sport, and the use of a multimodality approach for risk stratification and management.
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Affiliation(s)
- Richard P Allwood
- Cardiology Department, Baker Heart and Diabetes Institute, Melbourne, Australia
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3
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Mattesi G, Pergola V, Bariani R, Martini M, Motta R, Perazzolo Marra M, Rigato I, Bauce B. Multimodality imaging in arrhythmogenic cardiomyopathy - From diagnosis to management. Int J Cardiol 2024; 407:132023. [PMID: 38583594 DOI: 10.1016/j.ijcard.2024.132023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/03/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
Arrhythmogenic Cardiomyopathy (AC), an inherited cardiac disorder characterized by myocardial fibrofatty replacement, carries a significant risk of sudden cardiac death (SCD) due to ventricular arrhythmias. A comprehensive multimodality imaging approach, including echocardiography, cardiac magnetic resonance imaging (CMR), and cardiac computed tomography (CCT), allows for accurate diagnosis, effective risk stratification, vigilant monitoring, and appropriate intervention, leading to improved patient outcomes and the prevention of SCD. Echocardiography is primary tool ventricular morphology and function assessment, CMR provides detailed visualization, CCT is essential in early stages for excluding congenital anomalies and coronary artery disease. Echocardiography is preferred for follow-up, with CMR capturing changes over time. The strategic use of these imaging methods aids in confirming AC, differentiating it from other conditions, tracking its progression, managing complications, and addressing end-stage scenarios.
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Affiliation(s)
| | | | - Riccardo Bariani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Marika Martini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
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4
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Faga V, Ruiz Cueto M, Viladés Medel D, Moreno-Weidmann Z, Dallaglio PD, Diez Lopez C, Roura G, Guerra JM, Leta Petracca R, Gomez-Hospital JA, Comin Colet J, Anguera I, Di Marco A. Diagnostic and Prognostic Value of Right Ventricular Fat Quantification from Computed Tomography in Arrhythmogenic Right Ventricular Cardiomyopathy. J Clin Med 2024; 13:3674. [PMID: 38999240 PMCID: PMC11242505 DOI: 10.3390/jcm13133674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/15/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background: In arrhythmogenic right ventricular cardiomyopathy (ARVC) non-invasive scar evaluation is not included among the diagnostic criteria or the predictors of ventricular arrhythmias (VA) and sudden death (SD). Computed tomography (CT) has excellent spatial resolution and allows a clear distinction between myocardium and fat; thus, it has great potential for the evaluation of myocardial scar in ARVC. Objective: The objective of this study is to evaluate the feasibility, and the diagnostic and prognostic value of semi-automated quantification of right ventricular (RV) fat replacement from CT images. Methods: An observational case-control study was carried out including 23 patients with a definite (19) or borderline (4) ARVC diagnosis and 23 age- and sex-matched controls without structural heart disease. All patients underwent contrast-enhanced cardiac CT. RV images were semi-automatically reconstructed with the ADAS-3D software (ADAS3D Medical, Barcelona, Spain). A fibrofatty scar was defined as values of Hounsfield Units (HU) <-10. Within the scar, a border zone (between -10 HU and -50 HU) and dense scar (<-50 HU) were distinguished. Results: All ARVC patients had an RV scar and all scar-related measurements were significantly higher in ARVC cases than in controls (p < 0.001). The total scar area and dense scar area showed no overlapping values between cases and controls, achieving perfect diagnostic performance (sensitivity and specificity of 100%). Among ARVC patients, 16 (70%) had experienced sustained VA or aborted SD. Among all clinical, ECG and imaging parameters, the dense scar area was the only one with a statistically significant association with VA and SD (p = 0.003). Conclusions: In ARVC, RV myocardial fat quantification from CT is feasible and may have considerable diagnostic and prognostic value.
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Affiliation(s)
- Valentina Faga
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - María Ruiz Cueto
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - David Viladés Medel
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Cardiac Imaging Unit, Hospital de la Creu Blanca, 08034 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | | | - Paolo D. Dallaglio
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carles Diez Lopez
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gerard Roura
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Jose M. Guerra
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Institut de Recerca Sant Pau, 08041 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Rubén Leta Petracca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Cardiac Imaging Unit, Hospital de la Creu Blanca, 08034 Barcelona, Spain
| | - Joan Antoni Gomez-Hospital
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Josep Comin Colet
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Innovation, Research and Universities Department, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, 08007 Barcelona, Spain
| | - Ignasi Anguera
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Andrea Di Marco
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
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5
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Dong Z, Dai L, Song Y, Ma X, Wang J, Yu S, Yang S, Yang K, Zhao K, Lu M, Chen X, Zhao S. Right Ventricular Strain Derived from Cardiac MRI Feature Tracking for the Diagnosis and Prognosis of Arrhythmogenic Right Ventricular Cardiomyopathy. Radiol Cardiothorac Imaging 2024; 6:e230292. [PMID: 38842456 PMCID: PMC11211951 DOI: 10.1148/ryct.230292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/31/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024]
Abstract
Purpose To demonstrate the myocardial strain characteristics of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), based on revised Task Force Criteria (rTFC), and to explore the prognostic value of strain analysis in ARVC. Materials and Methods This retrospective study included 247 patients (median age, 38 years [IQR, 28-48 years]; 167 male, 80 female) diagnosed with ARVC, based on rTFC, between 2014 and 2018. Patients were divided into "possible" (n =25), "borderline" (n = 40), and "definite" (n = 182) ARVC groups following rTFC. Biventricular global strain parameters were calculated using cardiac MRI feature tracking (FT). The primary outcome was defined as a composite of cardiovascular events, including cardiovascular death, heart transplantation, and appropriate implantable cardioverter defibrillator discharge. Univariable and multivariable cumulative logistic regression and Cox proportional hazards regression analysis were used to evaluate the diagnostic and prognostic value of right ventricle (RV) strain parameters. Results Patients with definite ARVC had significantly reduced RV global strain in all three directions compared with possible or borderline groups (all P < .001). RV global longitudinal strain (GLS) was an independent predictor for disease (odds ratio, 1.09 [95% CI: 1.02, 1.16]; P = .009). During a median follow-up of 3.4 years (IQR, 2.0-4.9 years), 55 patients developed primary end point events. Multivariable analysis showed that RV GLS was independently associated with the occurrence of cardiovascular events (hazard ratio, 1.15 [95% CI: 1.07, 1.24]; P < .001). Kaplan-Meier analysis showed that patients with RV GLS worse than median had a higher risk of combined cardiovascular events (log-rank P < .001). Conclusion RV GLS derived from cardiac MRI FT demonstrated good diagnostic and prognostic value in ARVC. Keywords: MR Imaging, Image Postprocessing, Cardiac, Right Ventricle, Cardiomyopathies, Arrhythmogenic Right Ventricular Cardiomyopathy, Revised Task Force Criteria, Cardiovascular MR, Feature Tracking, Cardiovascular Events Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
| | | | - Yanyan Song
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Xuan Ma
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Jiaxin Wang
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Shiqin Yu
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Shujuan Yang
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Kai Yang
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Kankan Zhao
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Minjie Lu
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Xiuyu Chen
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
| | - Shihua Zhao
- From the Department of Magnetic Resonance Imaging, Fuwai Hospital,
National Center for Cardiovascular Diseases, State Key Laboratory of
Cardiovascular Disease, Chinese Academy of Medical Sciences Peking Union Medical
College, Beijing, China (Z.D., L.D., Y.S., X.M., J.W., S. Yu, S. Yang, K.Y.,
M.L., X.C.); Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen
Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
(K.Z.); Radiology Imaging Center, Fuwai Hospital, National Center for
Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease,
Beilishi Road No. 167, Xicheng District, Beijing 100037, China (S.Z.)
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Huang KY, Chung FP, Guo CY, Chiu JH, Kuo L, Lee YC, Weng CY, Chang YY, Lin YJ, Chen CK. Right ventricular scalloping index as cardiac magnetic resonance-derived marker for diagnosis of arrhythmogenic right ventricular cardiomyopathy. J Chin Med Assoc 2024; 87:531-537. [PMID: 38529961 DOI: 10.1097/jcma.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The cardiac magnetic resonance (CMR) evaluation of right ventricular (RV) morphologic abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is subjective. Here, we aimed to use a quantitative index, the right ventricular scalloping index (RVSI), to standardize the measurement of RV free wall scalloping and aid in the imaging diagnosis. METHODS We retrospectively included 15 patients with definite ARVC and 45 age- and sex-matched patients with idiopathic right ventricular outflow tract ventricular arrhythmia (RVOT-VA) as controls. The RVSI was measured from cine images on four-chamber view to evaluate its ability to distinguish between ARVC and RVOT-VA patients. Other cardiac functional parameters including strain analysis were also performed. RESULTS The RVSI was significantly higher in the ARVC than RVOT-VA group (1.56 ± 0.23 vs 1.30 ± 0.08, p < 0.001). The diagnostic performance of the RVSI was superior to the RV global longitudinal, circumferential, and radial strains, RV ejection fraction, and RV end-diastolic volume index. The RVSI demonstrated high intraobserver and interobserver reliability (intraclass correlation coefficient, 0.94 and 0.96, respectively). RVSI was a strong discriminator between ARVC and RVOT-VA patients (area under curve [AUC], 0.91; 95% CI, 0.82-0.99). A cutoff value of RVSI ≥1.49 provided an accuracy of 90.0%, specificity of 97.8%, sensitivity of 66.7%, positive predictive value (PPV) of 90.9%, and a negative predictive value (NPV) of 89.8%. In a multivariable analysis, a family history of ARVC or sudden cardiac death (odds ratio, 38.71; 95% CI, 1.48-1011.05; p = 0.028) and an RVSI ≥1.49 (odds ratio, 64.72; 95% CI, 4.58-914.63; p = 0.002) remained predictive of definite ARVC. CONCLUSION RVSI is a quantitative method with good performance for the diagnosis of definite ARVC.
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Affiliation(s)
- Ko-Ying Huang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chao-Yu Guo
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei Taiwan, ROC
| | - Jui-Han Chiu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Chi Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Yao Weng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Yueh Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cardiovascular Research Center, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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7
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Forleo C, Carella MC, Basile P, Mandunzio D, Greco G, Napoli G, Carulli E, Dicorato MM, Dentamaro I, Santobuono VE, Memeo R, Latorre MD, Baggiano A, Mushtaq S, Ciccone MM, Pontone G, Guaricci AI. The Role of Magnetic Resonance Imaging in Cardiomyopathies in the Light of New Guidelines: A Focus on Tissue Mapping. J Clin Med 2024; 13:2621. [PMID: 38731153 PMCID: PMC11084160 DOI: 10.3390/jcm13092621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Cardiomyopathies (CMPs) are a group of myocardial disorders that are characterized by structural and functional abnormalities of the heart muscle. These abnormalities occur in the absence of coronary artery disease (CAD), hypertension, valvular disease, and congenital heart disease. CMPs are an increasingly important topic in the field of cardiovascular diseases due to the complexity of their diagnosis and management. In 2023, the ESC guidelines on cardiomyopathies were first published, marking significant progress in the field. The growth of techniques such as cardiac magnetic resonance imaging (CMR) and genetics has been fueled by the development of multimodal imaging approaches. For the diagnosis of CMPs, a multimodal imaging approach, including CMR, is recommended. CMR has become the standard for non-invasive analysis of cardiac morphology and myocardial function. This document provides an overview of the role of CMR in CMPs, with a focus on tissue mapping. CMR enables the characterization of myocardial tissues and the assessment of cardiac functions. CMR sequences and techniques, such as late gadolinium enhancement (LGE) and parametric mapping, provide detailed information on tissue composition, fibrosis, edema, and myocardial perfusion. These techniques offer valuable insights for early diagnosis, prognostic evaluation, and therapeutic guidance of CMPs. The use of quantitative CMR markers enables personalized treatment plans, improving overall patient outcomes. This review aims to serve as a guide for the use of these new tools in clinical practice.
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Affiliation(s)
- Cinzia Forleo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Maria Cristina Carella
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Paolo Basile
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Donato Mandunzio
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Giulia Greco
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Gianluigi Napoli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Eugenio Carulli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Marco Maria Dicorato
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Ilaria Dentamaro
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Vincenzo Ezio Santobuono
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Riccardo Memeo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Michele Davide Latorre
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Marco Matteo Ciccone
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20138 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
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8
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Mauriello A, Roma AS, Ascrizzi A, Molinari R, Loffredo FS, D’Andrea A, Russo V. Arrhythmogenic Left Ventricular Cardiomyopathy: From Diagnosis to Risk Management. J Clin Med 2024; 13:1835. [PMID: 38610600 PMCID: PMC11012337 DOI: 10.3390/jcm13071835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE OF REVIEW Left ventricular arrhythmogenic cardiomyopathy (ALVC) is a rare and poorly characterized cardiomyopathy that has recently been reclassified in the group of non-dilated left ventricular cardiomyopathies. This review aims to summarize the background, diagnosis, and sudden cardiac death risk in patients presenting this cardiomyopathy. RECENT FINDINGS Although there is currently a lack of data on this condition, arrhythmogenic left ventricular dysplasia can be considered a specific disease of the left ventricle (LV). We have collected the latest evidence about the management and the risks associated with this cardiomyopathy. SUMMARY Left ventricular arrhythmogenic cardiomyopathy is still poorly characterized. ALVC is characterized by fibrofatty replacement in the left ventricular myocardium, with variable phenotypic expression. Diagnosis is based on a multiparametric approach, including cardiac magnetic resonance (CMR) and genetic testing, and is important for sudden cardiac death (SCD) risk stratification and management. Recent guidelines have improved the management of left ventricular arrhythmogenic cardiomyopathy. Further studies are necessary to improve knowledge of this cardiomyopathy.
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Affiliation(s)
- Alfredo Mauriello
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
- Unit of Cardiology, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy
| | - Anna Selvaggia Roma
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| | - Antonia Ascrizzi
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| | - Riccardo Molinari
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| | - Francesco S. Loffredo
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| | - Antonello D’Andrea
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
- Unit of Cardiology, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
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9
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Corrado D, Anastasakis A, Basso C, Bauce B, Blomström-Lundqvist C, Bucciarelli-Ducci C, Cipriani A, De Asmundis C, Gandjbakhch E, Jiménez-Jáimez J, Kharlap M, McKenna WJ, Monserrat L, Moon J, Pantazis A, Pelliccia A, Perazzolo Marra M, Pillichou K, Schulz-Menger J, Jurcut R, Seferovic P, Sharma S, Tfelt-Hansen J, Thiene G, Wichter T, Wilde A, Zorzi A. Proposed diagnostic criteria for arrhythmogenic cardiomyopathy: European Task Force consensus report. Int J Cardiol 2024; 395:131447. [PMID: 37844667 DOI: 10.1016/j.ijcard.2023.131447] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a heart muscle disease characterized by prominent "non-ischemic" myocardial scarring predisposing to ventricular electrical instability. Diagnostic criteria for the original phenotype, arrhythmogenic right ventricular cardiomyopathy (ARVC), were first proposed in 1994 and revised in 2010 by an international Task Force (TF). A 2019 International Expert report appraised these previous criteria, finding good accuracy for diagnosis of ARVC but a lack of sensitivity for identification of the expanding phenotypic disease spectrum, which includes left-sided variants, i.e., biventricular (ABVC) and arrhythmogenic left ventricular cardiomyopathy (ALVC). The ARVC phenotype together with these left-sided variants are now more appropriately named ACM. The lack of diagnostic criteria for the left ventricular (LV) phenotype has resulted in clinical under-recognition of ACM patients over the 4 decades since the disease discovery. In 2020, the "Padua criteria" were proposed for both right- and left-sided ACM phenotypes. The presently proposed criteria represent a refinement of the 2020 Padua criteria and have been developed by an expert European TF to improve the diagnosis of ACM with upgraded and internationally recognized criteria. The growing recognition of the diagnostic role of CMR has led to the incorporation of myocardial tissue characterization findings for detection of myocardial scar using the late‑gadolinium enhancement (LGE) technique to more fully characterize right, biventricular and left disease variants, whether genetic or acquired (phenocopies), and to exclude other "non-scarring" myocardial disease. The "ring-like' pattern of myocardial LGE/scar is now a recognized diagnostic hallmark of ALVC. Additional diagnostic criteria regarding LV depolarization and repolarization ECG abnormalities and ventricular arrhythmias of LV origin are also provided. These proposed upgrading of diagnostic criteria represents a working framework to improve management of ACM patients.
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Affiliation(s)
- Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy.
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Cristina Basso
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Barbara Bauce
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Carina Blomström-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Alberto Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis, Brussel - Vrije Universiteit Brussel, Belgium
| | - Estelle Gandjbakhch
- Sorbonne Universitè, APHP, Centre de Référence des Maladies Cardiaques héréditaires Groupe Hospitalier Pitié Salpêtrière-Charles Foix, Paris, France
| | | | - Maria Kharlap
- Department of cardiac arrhythmias, National Centre for Therapy and Preventive Medicine, Moscow, Petroverigsky, Russia
| | - William J McKenna
- Institute of Cardiovascular Science, University College London, United Kingdom
| | - Lorenzo Monserrat
- Cardiovascular Genetics, Medical Department, Dilemma Solutions SL, A Coruña, Spain
| | - James Moon
- CMR Service, Barts Heart Centre, University College London, United Kingdom
| | - Antonis Pantazis
- Inherited Cardiovascular Conditions services, The Royal Brompton and Harefield Hospitals, London, United Kingdom
| | | | - Martina Perazzolo Marra
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Kalliopi Pillichou
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Jeanette Schulz-Menger
- Charité, Universitätsmedizin Berlin, Campus Buch - ECRC and Helios Clinics, DZHK Partnersite Berlin, Germany
| | - Ruxandra Jurcut
- Expert Center for Rare Genetic Cardiovascular Diseases, Institute for Cardiovascular Diseases "Prof.dr.C.C.Iliescu", UMF "Carol Davila", Bucharest, Romania
| | - Petar Seferovic
- University of Belgrade, Faculty of Medicine and Heart Failure Center, Belgrade University Medical Center, Belgrade
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, United Kingdom
| | - Jacob Tfelt-Hansen
- Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gaetano Thiene
- University of Padua Medical School, ARCA Associazione Ricerche Cardiopatie Aritmiche ETS, Padova, Italy
| | - Thomas Wichter
- Dept. of Internal Medicine / Cardiology, Heart Center Osnabrück - Bad Rothenfelde, Niels-Stensen-Kliniken, Marienhospital Osnabrück, Osnabrück, Germany
| | - Arthur Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands
| | - Alessandro Zorzi
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
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10
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Dong Z, Ma X, Wang J, Yang S, Yu S, Song Y, Tang Y, Xiang X, Yang K, Zhao K, Lu M, Chen X, Zhao S. Incremental Diagnostic Value of Right Ventricular Strain Analysis in Arrhythmogenic Right Ventricular Cardiomyopathy. J Am Heart Assoc 2024; 13:e031403. [PMID: 38156506 PMCID: PMC10863820 DOI: 10.1161/jaha.123.031403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Strain analysis is a sensitive method for the assessment of ventricular structural or functional alterations. The authors aimed to determine whether right ventricular (RV) strain parameters can discriminate patients with revised Task Force Criteria-diagnosed arrhythmogenic RV cardiomyopathy (ARVC) incremental to the existing cardiovascular magnetic resonance (CMR) criteria, thus improving the diagnostic yield of CMR in ARVC. METHODS AND RESULTS A total of 74 patients with revised Task Force Criteria-diagnosed ARVC (37 borderline and 37 definite) and 37 controls were retrospectively enrolled for analysis. Using CMR feature tracking, RV global longitudinal (GLS), circumferential, and radial strain of all participants were evaluated. Compared with controls, the study patients demonstrated significantly impaired global biventricular strain in all 3 directions (all P<0.001). Receiver operating characteristic curve analysis indicated that RV GLS was the strongest discriminator among all RV strain parameters for the identification of patients with ARVC (area under the curve, 0.92). Using the Youden index, the authors determined RV GLS ≥-19.95% as the diagnostic criterion of ARVC. In patients diagnosed with borderline ARVC according to revised Task Force Criteria but with no or only minor CMR criteria, there were >50% presenting with impaired RV GLS. When both conventional criteria and RV GLS were considered together, this new diagnostic method demonstrated an overall diagnostic accuracy of 90%. The likelihood ratio test showed a significant incremental diagnostic value of RV GLS (P=0.02) over the existing CMR major criteria. CONCLUSIONS The current study showed an improved diagnostic accuracy when both RV GLS and the existing CMR criteria were considered together, especially for patients with borderline diagnosis, suggesting the incremental value of strain analysis to the initial assessment of ARVC.
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Affiliation(s)
- Zhixiang Dong
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiaxin Wang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shujuan Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shiqin Yu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yanyan Song
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yun Tang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiaorui Xiang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Kai Yang
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of SciencesSZ University TownShenzhenChina
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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11
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 371] [Impact Index Per Article: 371.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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12
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Castiglione V, Aimo A, Todiere G, Barison A, Fabiani I, Panichella G, Genovesi D, Bonino L, Clemente A, Cademartiri F, Giannoni A, Passino C, Emdin M, Vergaro G. Role of Imaging in Cardiomyopathies. Card Fail Rev 2023; 9:e08. [PMID: 37427006 PMCID: PMC10326670 DOI: 10.15420/cfr.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 07/11/2023] Open
Abstract
Imaging has a central role in the diagnosis, classification, and clinical management of cardiomyopathies. While echocardiography is the first-line technique, given its wide availability and safety, advanced imaging, including cardiovascular magnetic resonance (CMR), nuclear medicine and CT, is increasingly needed to refine the diagnosis or guide therapeutic decision-making. In selected cases, such as in transthyretin-related cardiac amyloidosis or in arrhythmogenic cardiomyopathy, the demonstration of histological features of the disease can be avoided when typical findings are observed at bone-tracer scintigraphy or CMR, respectively. Findings from imaging techniques should always be integrated with data from the clinical, electrocardiographic, biomarker, genetic and functional evaluation to pursue an individualised approach to patients with cardiomyopathy.
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Affiliation(s)
- Vincenzo Castiglione
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Alberto Aimo
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Giancarlo Todiere
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Andrea Barison
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Iacopo Fabiani
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Giorgia Panichella
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Dario Genovesi
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Lucrezia Bonino
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Alberto Clemente
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Filippo Cademartiri
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Alberto Giannoni
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Claudio Passino
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Michele Emdin
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Giuseppe Vergaro
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
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13
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Könemann H, Dagres N, Merino JL, Sticherling C, Zeppenfeld K, Tfelt-Hansen J, Eckardt L. Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects. Europace 2023; 25:euad091. [PMID: 37102266 PMCID: PMC10228619 DOI: 10.1093/europace/euad091] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/28/2023] Open
Abstract
Sudden cardiac death and ventricular arrhythmias are a global health issue. Recently, a new guideline for the management of ventricular arrhythmias and prevention of sudden cardiac death has been published by the European Society of Cardiology that serves as an update to the 2015 guideline on this topic. This review focuses on 10 novel key aspects of the current guideline: As new aspects, public basic life support and access to defibrillators are guideline topics. Recommendations for the diagnostic evaluation of patients with ventricular arrhythmias are structured according to frequently encountered clinical scenarios. Management of electrical storm has become a new focus. In addition, genetic testing and cardiac magnetic resonance imaging significantly gained relevance for both diagnostic evaluation and risk stratification. New algorithms for antiarrhythmic drug therapy aim at improving safe drug use. The new recommendations reflect increasing relevance of catheter ablation of ventricular arrhythmias, especially in patients without structural heart disease or stable coronary artery disease with only mildly impaired ejection fraction and haemodynamically tolerated ventricular tachycardias. Regarding sudden cardiac death risk stratification, risk calculators for laminopathies, and long QT syndrome are now considered besides the already established risk calculator for hypertrophic cardiomyopathy. Generally, 'new' risk markers beyond left ventricular ejection fraction are increasingly considered for recommendations on primary preventive implantable cardioverter defibrillator therapy. Furthermore, new recommendations for diagnosis of Brugada syndrome and management of primary electrical disease have been included. With many comprehensive flowcharts and practical algorithms, the new guideline takes a step towards a user-oriented reference book.
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Affiliation(s)
- Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - José Luis Merino
- Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
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14
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Bourfiss M, Sander J, de Vos BD, Te Riele ASJM, Asselbergs FW, Išgum I, Velthuis BK. Towards automatic classification of cardiovascular magnetic resonance Task Force Criteria for diagnosis of arrhythmogenic right ventricular cardiomyopathy. Clin Res Cardiol 2023; 112:363-378. [PMID: 36066609 PMCID: PMC9998324 DOI: 10.1007/s00392-022-02088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is diagnosed according to the Task Force Criteria (TFC) in which cardiovascular magnetic resonance (CMR) imaging plays an important role. Our study aims to apply an automatic deep learning-based segmentation for right and left ventricular CMR assessment and evaluate this approach for classification of the CMR TFC. METHODS We included 227 subjects suspected of ARVC who underwent CMR. Subjects were classified into (1) ARVC patients fulfilling TFC; (2) at-risk family members; and (3) controls. To perform automatic segmentation, a Bayesian Dilated Residual Neural Network was trained and tested. Performance of automatic versus manual segmentation was assessed using Dice-coefficient and Hausdorff distance. Since automatic segmentation is most challenging in basal slices, manual correction of the automatic segmentation in the most basal slice was simulated (automatic-basal). CMR TFC calculated using manual and automatic-basal segmentation were compared using Cohen's Kappa (κ). RESULTS Automatic segmentation was trained on CMRs of 70 subjects (39.6 ± 18.1 years, 47% female) and tested on 157 subjects (36.9 ± 17.6 years, 59% female). Dice-coefficient and Hausdorff distance showed good agreement between manual and automatic segmentations (≥ 0.89 and ≤ 10.6 mm, respectively) which further improved after simulated correction of the most basal slice (≥ 0.92 and ≤ 9.2 mm, p < 0.001). Pearson correlation of volumetric and functional CMR measurements was good to excellent (automatic (r = 0.78-0.99, p < 0.001) and automatic-basal (r = 0.88-0.99, p < 0.001) measurements). CMR TFC classification using automatic-basal segmentations was comparable to manual segmentations (κ 0.98 ± 0.02) with comparable diagnostic performance. CONCLUSIONS Combining automatic segmentation of CMRs with correction of the most basal slice results in accurate CMR TFC classification of subjects suspected of ARVC.
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Affiliation(s)
- Mimount Bourfiss
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Jörg Sander
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bob D de Vos
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands
| | - Anneline S J M Te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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15
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Nazer B, Cheng RK. An Opportunity to Refine Our Understanding of Right Ventricular Involvement in Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2023; 16:S1936-878X(22)00733-1. [PMID: 36881414 DOI: 10.1016/j.jcmg.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 02/24/2023]
Affiliation(s)
- Babak Nazer
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA. https://twitter.com/B_Naz_MD
| | - Richard K Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA.
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16
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 883] [Impact Index Per Article: 441.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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17
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Certainties and Uncertainties of Cardiac Magnetic Resonance Imaging in Athletes. J Cardiovasc Dev Dis 2022; 9:jcdd9100361. [PMID: 36286312 PMCID: PMC9604894 DOI: 10.3390/jcdd9100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Prolonged and intensive exercise induces remodeling of all four cardiac chambers, a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation, however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated, arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden cardiac death. Cardiac magnetic resonance (CMR) is a well-suited, highly reproducible imaging modality that can help differentiate athlete’s heart from cardiomyopathy. CMR allows accurate characterization of the morphology and function of cardiac chambers, providing full coverage of the ventricles. Moreover, it permits an in-depth understanding of the myocardial changes through specific techniques such as mapping or late gadolinium enhancement. In this narrative review, we will focus on the certainties and uncertainties of the role of CMR in sports cardiology. The main aspects of physiological adaptation due to regular and intensive sports activity and the application of CMR in highly trained athletes will be summarized.
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18
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Marchetti M, Pascale P, Muller O, Lu H. [Arrhythmogenic right ventricular cardiomyopathy : An update]. Ann Cardiol Angeiol (Paris) 2022; 71:223-227. [PMID: 36089416 DOI: 10.1016/j.ancard.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy is a hereditary myocardial condition in most cases that affects the right ventricle, but also the left ventricle with variable degree. It predisposes patients to ventricular arrhythmia, heart failure and sudden death. Its diagnosis remains challenging and is mostly based on reference task-force criteria. The latter, divided between major and minor criteria, include structural abnormalities (visualized on echocardiography or cardiac magnetic resonance), electrocardiographic anomalies, ventricular arrythmia documentation, histological proof of fibro-fatty infiltrates within myocardial tissue and family history. Following a correct diagnosis, patient-tailored care is essential. First, implantation of an implantable cardioverter-defibrillator is recommended in case of history of sudden death, sustained ventricular tachycardia or advanced right/left ventricular dysfunction. It should be considered in case of cardiac syncope or non-sustained ventricular tachycardia. Secondly, eviction of high intensity physical activity is mandatory. Finally, beta-blockers are recommended for all patients with clinically manifest arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- Matteo Marchetti
- Service de médecine interne, Centre hospitalier universitaire vaudois, Rue du Bugnon 46, 1011 Lausanne, Suisse.
| | - Patrizio Pascale
- Service de cardiologie, Centre hospitalier universitaire vaudois, Rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Olivier Muller
- Service de cardiologie, Centre hospitalier universitaire vaudois, Rue du Bugnon 46, 1011 Lausanne, Suisse
| | - Henri Lu
- Service de cardiologie, Centre hospitalier universitaire vaudois, Rue du Bugnon 46, 1011 Lausanne, Suisse
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19
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Diagnosing arrhythmogenic right ventricular cardiomyopathy: Is an image always worth a thousand words? PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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20
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Cardiac magnetic resonance imaging of arrhythmogenic cardiomyopathy: evolving diagnostic perspectives. Eur Radiol 2022; 33:270-282. [PMID: 35788758 DOI: 10.1007/s00330-022-08958-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 01/09/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined heart muscle disease characterized by fibro-fatty myocardial replacement, clinically associated with malignant ventricular arrhythmias and sudden cardiac death. Originally described a disease with a prevalent right ventricular (RV) involvement, subsequently two other phenotypes have been recognized, such as the left dominant and the biventricular phenotypes, for which a recent International Expert consensus document provided upgrade diagnostic criteria (the 2020 "Padua Criteria"). In this novel workup for the diagnosis of the entire spectrum of phenotypic variants of ACM, including left ventricular (LV) variants, cardiac magnetic resonance (CMR) has emerged as the cardiac imaging technique of choice, due to its capability of detailed morpho-functional and tissue characterization evaluation of both RV and LV. In this review, the key role of CMR in the diagnosis of ACM is outlined, including the supplemental value for the characterization of the disease variants. An ACM-specific CMR study protocol, as well as strengths and weaknesses of each imaging technique, is also provided. KEY POINTS: • Arrhythmogenic cardiomyopathy includes three different phenotypes: dominant right, biventricular, and dominant left. • In 2020, diagnostic criteria have been updated and cardiac magnetic resonance has emerged as the cardiac imaging technique of choice. • This aim of this review is to provide an update of the current state of art regarding the use of CMR in ACM, with a particular focus on novel diagnostic criteria, CMR protocols, and prognostic significance of CMR findings in ACM.
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21
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Malik N, Mukherjee M, Wu KC, Zimmerman SL, Zhan J, Calkins H, James CA, Gilotra NA, Sheikh FH, Tandri H, Kutty S, Hays AG. Multimodality Imaging in Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Cardiovasc Imaging 2022; 15:e013725. [PMID: 35147040 DOI: 10.1161/circimaging.121.013725] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare, heritable myocardial disease associated with the development of ventricular arrhythmias, heart failure, and sudden cardiac death in early adulthood. Multimodality imaging is a central component in the diagnosis and evaluation of ARVC. Diagnostic criteria established by an international task force in 2010 include noninvasive parameters from echocardiography and cardiac magnetic resonance imaging. These criteria identify right ventricular structural abnormalities, chamber and outflow tract dilation, and reduced right ventricular function as features of ARVC. Echocardiography is a widely available and cost-effective technique, and it is often selected for initial evaluation. Beyond fulfillment of diagnostic criteria, features such as abnormal tricuspid annular plane excursion, increased right ventricular basal diameter, and abnormal strain patterns have been described. 3-dimensional echocardiography may also expand opportunities for structural and functional assessment of ARVC. Cardiac magnetic resonance has the ability to assess morphological and functional cardiac features of ARVC and is also a core modality in evaluation, however, tissue characterization of the right ventricle is limited by spatial resolution and low specificity for detection of pathological changes. Nonetheless, the ability of cardiac magnetic resonance to identify left ventricular involvement, offer high negative predictive value, and provide a reproducible structural evaluation of the right ventricle enhance the ability and scope of the modality. In this review, the prognostic significance of multimodality imaging is outlined, including the supplemental value of multidetector computed tomography and nuclear imaging. Strengths and weaknesses of imaging techniques, as well as future direction of multimodality assessment, are also described.
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Affiliation(s)
- Nitin Malik
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (N.M., F.H.S.).,Georgetown University, Washington, DC (N.M., F.H.S.)
| | - Monica Mukherjee
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Katherine C Wu
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Stefan L Zimmerman
- Johns Hopkins University Department of Radiology, Baltimore, MD (S.L.Z.)
| | - Junzhen Zhan
- Johns Hopkins University Department of Pediatrics, Division of Pediatric Cardiology, Baltimore, MD (J.Z., S.K.)
| | - Hugh Calkins
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Cynthia A James
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Nisha A Gilotra
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Farooq H Sheikh
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (N.M., F.H.S.).,Georgetown University, Washington, DC (N.M., F.H.S.)
| | - Harikrishna Tandri
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Shelby Kutty
- Johns Hopkins University Department of Pediatrics, Division of Pediatric Cardiology, Baltimore, MD (J.Z., S.K.)
| | - Allison G Hays
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
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22
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Graziano F, Zorzi A, Cipriani A, De Lazzari M, Bauce B, Rigato I, Brunetti G, Pilichou K, Basso C, Perazzolo Marra M, Corrado D. The 2020 "Padua Criteria" for Diagnosis and Phenotype Characterization of Arrhythmogenic Cardiomyopathy in Clinical Practice. J Clin Med 2022; 11:jcm11010279. [PMID: 35012021 PMCID: PMC8746198 DOI: 10.3390/jcm11010279] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 12/04/2022] Open
Abstract
Arrhythmogenic Cardiomyopathy (ACM) is a heredo-familial cardiac disease characterized by fibro-fatty myocardial replacement and increased risk of sudden cardiac death. The diagnosis of ACM can be challenging due to the lack of a single gold-standard test: for this reason, it is required to satisfy a combination of multiple criteria from different categories including ventricular morpho-functional abnormalities, repolarization and depolarization ECG changes, ventricular arrhythmias, tissue characterization findings and positive family history/molecular genetics. The first diagnostic criteria were published by an International Task Force (ITF) of experts in 1994 and revised in 2010 with the aim to increase sensitivity for early diagnosis. Limitations of the 2010 ITF criteria include the absence of specific criteria for left ventricle (LV) involvement and the limited role of cardiac magnetic resonance (CMR) as the use of the late gadolinium enhancement technique for tissue characterization was not considered. In 2020, new diagnostic criteria ("the Padua criteria") were proposed. The traditional organization in six categories of major/minor criteria was maintained. The criteria for identifying the right ventricular involvement were modified and a specific set of criteria for identifying LV involvement was created. Depending on the combination of criteria for right and LV involvement, a diagnosis of classic (right dominant) ACM, biventricular ACM or left-dominant ACM is then made. The article reviews the rationale of the Padua criteria, summarizes the main modifications compared to the previous 2010 ITF criteria and provides three examples of the application of the Padua criteria in clinical practice.
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23
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Abstract
PURPOSE OF REVIEW Review the current state of the art of arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnosis and risk stratification in the pediatric population. RECENT FINDINGS ARVC is an inherited cardiomyopathy characterized by progressive myocyte loss and fibrofatty replacement of predominantly the right ventricle and high risk of ventricular arrhythmias and sudden cardiac death (SCD). ARVC is one of the leading causes of arrhythmic cardiac arrest in young people. Early diagnosis and accurate risk assessment are challenging, especially in children who often exhibit little to no phenotype, even if genotype positive. Multimodal imaging provides more detailed assessment of the right ventricle and has been shown in pediatric patients to identify earlier preclinical disease expression. Identification of patients with ARVC allows the clinician to intervene early with appropriate exercise restrictions, even if genotype positive only without phenotypic expression. Emphasis should be placed on stratifying the patient's risk of ventricular arrhythmias and SCD. SUMMARY ARVC is a challenging diagnosis to make in adolescents who often do not exhibit clinical symptoms. Newer multimodal imaging techniques and improvements in genetic testing and biomarkers should help improve early diagnosis. Exercise restriction for children with ARVC has been shown to reduce disease advancement and decreases the risk of a life-threatening event.
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24
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Pathogenesis, Diagnosis and Risk Stratification in Arrhythmogenic Cardiomyopathy. CARDIOGENETICS 2021. [DOI: 10.3390/cardiogenetics11040025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined myocardial disease associated with sudden cardiac death (SCD). It is most frequently caused by mutations in genes encoding desmosomal proteins. However, there is growing evidence that ACM is not exclusively a desmosome disease but rather appears to be a disease of the connexoma. Fibroadipose replacement of the right ventricle (RV) had long been the hallmark of ACM, although biventricular involvement or predominant involvement of the left ventricle (LD-ACM) is increasingly found, raising the challenge of differential diagnosis with arrhythmogenic dilated cardiomyopathy (a-DCM). A-DCM, ACM, and LD-ACM are increasingly acknowledged as a single nosological entity, the hallmark of which is electrical instability. Our aim was to analyze the complex molecular mechanisms underlying arrhythmogenic cardiomyopathies, outlining the role of inflammation and autoimmunity in disease pathophysiology. Secondly, we present the clinical tools used in the clinical diagnosis of ACM. Focusing on the challenge of defining the risk of sudden death in this clinical setting, we present available risk stratification strategies. Lastly, we summarize the role of genetics and imaging in risk stratification, guiding through the appropriate patient selection for ICD implantation.
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25
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Corrado D, Zorzi A, Cipriani A, Bauce B, Bariani R, Beffagna G, De Lazzari M, Migliore F, Pilichou K, Rampazzo A, Rigato I, Rizzo S, Thiene G, Perazzolo Marra M, Basso C. Evolving Diagnostic Criteria for Arrhythmogenic Cardiomyopathy. J Am Heart Assoc 2021; 10:e021987. [PMID: 34533054 PMCID: PMC8649536 DOI: 10.1161/jaha.121.021987] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Criteria for diagnosis of arrhythmogenic cardiomyopathy (ACM) were first proposed in 1994 and revised in 2010 by a Task Force. Although the Task Force criteria demonstrated a good accuracy for diagnosis of the original right ventricular phenotype (arrhythmogenic right ventricular cardiomyopathy), they lacked sensitivity for identification of the expanding phenotypic spectrum of ACM, which includes left‐sided variants and did not incorporate late‐gadolinium enhancement findings by cardiac magnetic resonance. The 2020 International criteria (“Padua criteria”) have been developed by International experts with the aim to improve the diagnosis of ACM by providing new criteria for the diagnosis of left ventricular phenotypic features. The key upgrade was the incorporation of tissue characterization findings by cardiac magnetic resonance for noninvasive detection of late‐gadolinium enhancement/myocardial fibrosis that are determinants for characterization of arrhythmogenic biventricular and left ventricular cardiomyopathy. The 2020 International criteria are heavily dependent on cardiac magnetic resonance, which has become mandatory to characterize the ACM phenotype and to exclude other diagnoses. New criteria regarding left ventricular depolarization and repolarization ECG abnormalities and ventricular arrhythmias of left ventricular origin were also provided. This article reviews the evolving approach to diagnosis of ACM, going back to the 1994 and 2010 International Task Force criteria and then grapple with the modern 2020 International criteria.
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Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Riccardo Bariani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Giorgia Beffagna
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | | | - Ilaria Rigato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health University of Padova Italy
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26
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Heidbuchel H, Arbelo E, D'Ascenzi F, Borjesson M, Boveda S, Castelletti S, Miljoen H, Mont L, Niebauer J, Papadakis M, Pelliccia A, Saenen J, Sanz de la Garza M, Schwartz PJ, Sharma S, Zeppenfeld K, Corrado D. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators. Europace 2021; 23:147-148. [PMID: 32596731 DOI: 10.1093/europace/euaa106] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This paper belongs to a series of recommendation documents for participation in leisure-time physical activity and competitive sports by the European Association of Preventive Cardiology (EAPC). Together with an accompanying paper on supraventricular arrhythmias, this second text deals specifically with those participants in whom some form of ventricular rhythm disorder is documented, who are diagnosed with an inherited arrhythmogenic condition, and/or who have an implanted pacemaker or cardioverter defibrillator. A companion text on recommendations in athletes with supraventricular arrhythmias is published in the European Journal of Preventive Cardiology. Since both texts focus on arrhythmias, they are the result of a collaboration between EAPC and the European Heart Rhythm Association (EHRA). The documents provide a framework for evaluating eligibility to perform sports, based on three elements, i.e. the prognostic risk of the arrhythmias when performing sports, the symptomatic impact of arrhythmias while performing sports, and the potential progression of underlying structural problems as the result of sports.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mats Borjesson
- Centre for Health and Performance (CHP), Department of Food, Nutrition and Sport Sciences, Gothenburg University, Sweden.,Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Hielko Miljoen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi 46, Rome, Italy
| | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | | | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Domenico Corrado
- Department of Cardiology, University of Padova, Padova, Italy.,Department of Pathology, University of Padova, Padova, Italy
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27
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Fabiani I, Aimo A, Grigoratos C, Castiglione V, Gentile F, Saccaro LF, Arzilli C, Cardinale D, Passino C, Emdin M. Oxidative stress and inflammation: determinants of anthracycline cardiotoxicity and possible therapeutic targets. Heart Fail Rev 2021; 26:881-890. [PMID: 33319255 PMCID: PMC8149360 DOI: 10.1007/s10741-020-10063-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 12/04/2022]
Abstract
Chemotherapy with anthracycline-based regimens remains a cornerstone of treatment of many solid and blood tumors but is associated with a significant risk of cardiotoxicity, which can manifest as asymptomatic left ventricular dysfunction or overt heart failure. These effects are typically dose-dependent and cumulative and may require appropriate screening strategies and cardioprotective therapies in order to minimize changes to anticancer regimens or even their discontinuation. Our current understanding of cardiac damage by anthracyclines includes a central role of oxidative stress and inflammation. The identification of these processes through circulating biomarkers or imaging techniques might then be helpful for early diagnosis and risk stratification. Furthermore, therapeutic strategies relieving oxidative stress and inflammation hold promise to prevent heart failure development or at least to mitigate cardiac damage, although further evidence is needed on their efficacy, either alone or as part of combination therapies with neurohormonal antagonists, which are the current adopted standard.
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Affiliation(s)
- Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alberto Aimo
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
| | | | | | | | - Luigi F Saccaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy
| | - Claudio Passino
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Emdin
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
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28
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Gasperetti A, James CA, Cerrone M, Delmar M, Calkins H, Duru F. Arrhythmogenic right ventricular cardiomyopathy and sports activity: from molecular pathways in diseased hearts to new insights into the athletic heart mimicry. Eur Heart J 2021; 42:1231-1243. [PMID: 33200174 DOI: 10.1093/eurheartj/ehaa821] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/12/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease associated with a high risk of sudden cardiac death. Among other factors, physical exercise has been clearly identified as a strong determinant of phenotypic expression of the disease, arrhythmia risk, and disease progression. Because of this, current guidelines advise that individuals with ARVC should not participate in competitive or frequent high-intensity endurance exercise. Exercise-induced electrical and morphological para-physiological remodelling (the so-called 'athlete's heart') may mimic several of the classic features of ARVC. Therefore, the current International Task Force Criteria for disease diagnosis may not perform as well in athletes. Clear adjudication between the two conditions is often a real challenge, with false positives, that may lead to unnecessary treatments, and false negatives, which may leave patients unprotected, both of which are equally inacceptable. This review aims to summarize the molecular interactions caused by physical activity in inducing cardiac structural alterations, and the impact of sports on arrhythmia occurrence and other clinical consequences in patients with ARVC, and help the physicians in setting the two conditions apart.
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Affiliation(s)
- Alessio Gasperetti
- Division of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Cynthia A James
- Division of Cardiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Marina Cerrone
- Leon H Charney Division of Cardiology, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA
| | - Mario Delmar
- Leon H Charney Division of Cardiology, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Firat Duru
- Division of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.,Center for Integrative Human Physiology, University of Zurich, Rämistrasse 71, Zurich 8006, Switzerland
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29
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Liu Y, Yu J, Liu J, Wu B, Cui Q, Shen W, Xia S. Prognostic value of late gadolinium enhancement in arrhythmogenic right ventricular cardiomyopathy: a meta-analysis. Clin Radiol 2021; 76:628.e9-628.e15. [PMID: 34024635 DOI: 10.1016/j.crad.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/14/2021] [Indexed: 01/11/2023]
Abstract
AIM To assess systematically the prognostic value of cardiac magnetic resonance imaging (CMRI) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). MATERIALS AND METHODS The full text of studies of the clinical efficacy of late gadolinium enhancement (LGE) in ARVC was retrieved in multiple databases. Stata 14 was adopted for meta-analysis and bias analysis. Heterogeneity was assessed with the I2 statistic. RESULTS After exclusions, 561 patients were included in five studies, and the eligibility criteria were met. The meta-analysis suggested that there was a significant difference between LGE positive and negative patients with ARVC in all-cause mortality (relative risk [RR] = 4.78, 95% confidence interval [CI] = 1.41, 16.23, p=0.012; p for heterogeneity = 0.692, I2 = 0%); major adverse cardiovascular events (MACE) (RR=2.48, 95% CI = 1.24, 4.96, p=0.010; p for heterogeneity = 0.596, I2 = 0%); ventricular tachycardia (RR=3.13, 95% CI = 1.69, 5.78, p<0.001; p for heterogeneity = 0.825, I2 = 0%); implanted cardiac defibrillators (RR=3.15, 95% CI = 1.69, 5.87], p<0.001; p for heterogeneity = 0.353, I2 = 9.4%). CONCLUSION LGE in ARVC patients is a predictor of all-cause mortality and MACE.
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Affiliation(s)
- Y Liu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - J Yu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - J Liu
- Outpatient Department, Tianjin Third Central Hospital, No. 83, Jintang Road, Hedong District, Tianjin, 300000, China
| | - B Wu
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - Q Cui
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China
| | - W Shen
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China.
| | - S Xia
- Department of Radiology, Tianjin First Central Hospital, No. 24, Fukang Road, Nankai District, Tianjin, 300000, China.
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30
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Bosman LP, Te Riele ASJM. Arrhythmogenic right ventricular cardiomyopathy: a focused update on diagnosis and risk stratification. Heart 2021; 108:90-97. [PMID: 33990412 DOI: 10.1136/heartjnl-2021-319113] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterised by fibrofatty replacement of predominantly the right ventricle and high risk of ventricular arrhythmias and sudden cardiac death (SCD). Early diagnosis and accurate risk assessment are challenging yet essential for SCD prevention. This manuscript summarises the current state of the art on ARVC diagnosis and risk stratification. Improving the 2010 diagnostic criteria is an ongoing discussion. Several studies suggest that early diagnosis may be facilitated by including deformation imaging ('strain') for objective assessment of wall motion abnormalities, which was shown to have high sensitivity for preclinical disease. Adding fibrofatty replacement detected by late gadolinium enhancement or T1 mapping in cardiac MRI as criterion for diagnosis is increasingly suggested but requires more supporting evidence from consecutive patient cohorts. In addition to the traditional right-dominant ARVC, standard criteria for arrhythmogenic cardiomyopathy (ACM) and arrhythmogenic left ventricular cardiomyopathy (ALVC) are on the horizon. After diagnosis confirmation, the primary management goal is SCD prevention, for which an implantable cardioverter-defibrillator is the only proven therapy. Prior studies determined that younger age, male sex, previous (non-) sustained ventricular tachycardia, syncope, extent of T-wave inversion, frequent premature ectopic beats and lower biventricular ejection fraction are risk factors for subsequent events. Previous implantable cardioverter-defibrillator indication guidelines were however limited to three expert-opinion flow charts stratifying patients in risk groups. Now, two multivariable risk prediction models (arvcrisk.com) combine the abovementioned risk factors to estimate individual risks. Of note, both the flow charts and prediction models require clinical validation studies to determine which should be recommended.
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Affiliation(s)
- Laurens P Bosman
- Cardiology, UMC Utrecht, Utrecht, The Netherlands.,ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anneline S J M Te Riele
- Cardiology, UMC Utrecht, Utrecht, The Netherlands .,ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
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31
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Corrado D, van Tintelen PJ, McKenna WJ, Hauer RNW, Anastastakis A, Asimaki A, Basso C, Bauce B, Brunckhorst C, Bucciarelli-Ducci C, Duru F, Elliott P, Hamilton RM, Haugaa KH, James CA, Judge D, Link MS, Marchlinski FE, Mazzanti A, Mestroni L, Pantazis A, Pelliccia A, Marra MP, Pilichou K, Platonov PGA, Protonotarios A, Rampazzo A, Saffitz JE, Saguner AM, Schmied C, Sharma S, Tandri H, Te Riele ASJM, Thiene G, Tsatsopoulou A, Zareba W, Zorzi A, Wichter T, Marcus FI, Calkins H. Arrhythmogenic right ventricular cardiomyopathy: evaluation of the current diagnostic criteria and differential diagnosis. Eur Heart J 2021; 41:1414-1429. [PMID: 31637441 PMCID: PMC7138528 DOI: 10.1093/eurheartj/ehz669] [Citation(s) in RCA: 161] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/04/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Peter J van Tintelen
- Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands.,Department of Genetics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - William J McKenna
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, 7GR5+RW Doha, Qatar.,Institute of Cardiovascular Science, University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
| | - Richard N W Hauer
- Department of Cardiology, Netherlands Heart Institute, University Medical Center Utrecht, Moreelsepark 1, 3511 EP Utrecht, Netherlands
| | - Aris Anastastakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Leof. Andrea Siggrou 356, Kallithea 176 74, Greece
| | - Angeliki Asimaki
- Molecular and Clinical Sciences Research Institute, St. George's University of London NHS Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Foundation, Trust Headquarters, Marlborough St, Bristol BS1 3NU, UK
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, 62 Huntley St, Fitzrovia, London WC1E 6DD, UK
| | - Robert M Hamilton
- The Labatt Family Heart Centre and Division of Cardiology, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Canada
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Problemveien 7, 0315 Oslo, Norway
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Daniel Judge
- Department of Medicine, Medical University of South Carolina (MUSC), 30 Courtenay Drive Room 326 Gazes, Charleston, MSC 592, USA
| | - Mark S Link
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Francis E Marchlinski
- Cardiac Electrophysiology Program, Cardiovascular Division Hospital of the University of Pennsylvania, 9 Founders Pavilion - Cardiology, 3400 Spruce St., Philadelphia, PA, 19104, USA
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Corso Str. Nuova 25, Pavia, Italy
| | - Luisa Mestroni
- Molecular Genetics, Cardiovascular Institute, University of Colorado, Denver Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, USA
| | - Antonis Pantazis
- Inherited Cardiovascular Conditions services, The Royal Brompton and Harefield Hospitals, Sydney St, Chelsea, London SW3 6NP, UK
| | - Antonio Pelliccia
- Department of Cardiology, Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Roma, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Pyotr G A Platonov
- Department of Cardiology, Lund University Arrhythmia Clinic, Skåne University Hospital, Entrégatan 7, 222 42 Lund, Sweden
| | - Alexandros Protonotarios
- Inherited Cardiovascular Disease Unit, Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London EC1A 7BE, UK
| | - Alessandra Rampazzo
- Department of Biology, University of Padua, Viale Giuseppe Colombo, 3, 35131 Padova PD, Italy
| | - Jeffry E Saffitz
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
| | - Hari Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Anneline S J M Te Riele
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.,Netherlands Heart Institute, Utrecht, Moreelsepark 1, 3511 EP Utrecht, Netherlands
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | | | - Wojciech Zareba
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 150 Lucius Gordon Dr, West Henrietta, NY 14586, USA
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padova, Italy
| | - Thomas Wichter
- Heart Center Osnabrück, Bad Rothenfelde Niels-Stensen-Kliniken Marienhospital Osnabrück, Ulmenallee 5 - 11, 49214 Bad Rothenfelde, Germany
| | - Frank I Marcus
- Sarver Heart Center, The University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
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Abstract
PURPOSE OF REVIEW Aim of the paper was to address all strengths and weakness of cardiac magnetic resonance (CMR) in arrhythmogenic cardiomyopathy, trying to highlight areas where further research and investigations should be carried out to fill current gaps in scientific knowledge. RECENT FINDINGS Arrhythmogenic cardiomyopathy represents a multifaceted clinical entity associated with arrhythmias and sudden death. Even though different diagnostic tools are available for appropriate identification and risk stratification, over the last few years cardiac magnetic resonance (CMR) has surfaced as an unmatched non-invasive imaging tool. CMR is mandatory in the evaluation of arrhythmogenic cardiomyopathy. It is the only imaging technique providing the identification of myocardial fibrosis, particularly for left ventricular myocardium, as recent evidences demonstrated that left ventricular involvement in arrhythmogenic cardiomyopathy is associated with greater risk of sudden death than lone right ventricular involvement.
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33
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Fonseca AC, Almeida AG, Santos MO, Ferro JM. Neurological complications of cardiomyopathies. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:91-109. [PMID: 33632460 DOI: 10.1016/b978-0-12-819814-8.00001-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
There is a multifaceted relationship between the cardiomyopathies and a wide spectrum of neurological disorders. Severe acute neurological events, such as a status epilepticus and aneurysmal subarachnoid hemorrhage, may result in an acute cardiomyopathy the likes of Takotsubo cardiomyopathy. Conversely, the cardiomyopathies may result in a wide array of neurological disorders. Diagnosis of a cardiomyopathy may have already been established at the time of the index neurological event, or the neurological event may have prompted subsequent cardiac investigations, which ultimately lead to the diagnosis of a cardiomyopathy. The cardiomyopathies belong to one of the many phenotypes of complex genetic diseases or syndromes, which may also involve the central or peripheral nervous systems. A number of exogenous agents or risk factors such as diphtheria, alcohol, and several viruses may result in secondary cardiomyopathies accompanied by several neurological manifestations. A variety of neuromuscular disorders, such as myotonic dystrophy or amyloidosis, may demonstrate cardiac involvement during their clinical course. Furthermore, a number of genetic cardiomyopathies phenotypically incorporate during their clinical evolution, a gamut of neurological manifestations, usually neuromuscular in nature. Likewise, neurological complications may be the result of diagnostic procedures or medications for the cardiomyopathies and vice versa. Neurological manifestations of the cardiomyopathies are broad and include, among others, transient ischemic attacks, ischemic strokes, intracranial hemorrhages, syncope, muscle weakness and atrophy, myotonia, cramps, ataxia, seizures, intellectual developmental disorder, cognitive impairment, dementia, oculomotor palsies, deafness, retinal involvement, and headaches.
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Affiliation(s)
- Ana Catarina Fonseca
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ana G Almeida
- Cardiology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Miguel Oliveira Santos
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - José M Ferro
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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Huerta Robles R, Chávez Solsol F, Muñoz Moreno J, Ortecho Llanos D, Cabrera Saldaña M, Rodríguez Urteaga Z, Gutiérrez Garibay M. [Clinical profile and therapeutic strategies in patients with arrhythmogenic cardiomyopathy treated in a national reference institute]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:3-14. [PMID: 37727260 PMCID: PMC10506560 DOI: 10.47487/apcyccv.v2i1.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 09/21/2023]
Abstract
Objective To determine the epidemiological, clinical, electrocardiographic, imaging characteristics and main therapeutic strategies performed in patients with arrhythmogenic cardiomyopathy treated in a national reference cardiovascular institute. Materials and methods Observational, descriptive and retrospective study that attempts to identify the clinical characteristics, complementary tests and therapeutic strategies performed in patients with arrhythmogenic cardiomyopathy treated at the Instituto Nacional Cardiovascular - INCOR EsSalud in Lima, Peru. Results Thirteen patients were found with arrhythmogenic cardiomyopathy. The median age at which the diagnosis was made was 38.2 years and 69.3% were male. The most frequent clinical manifestations were tachycardic palpitations (92.3%), presyncope (84.6%) and heart failure (69.2%). 23% of the patients suffered a cardiac arrest. All the patients presented at least one episode of ventricular tachycardia, 92.3% with complete left bundle branch block morphology and upper axis. 76.9% received an implantable cardioverter defibrillator (ICD), 15.3% underwent ablation and 15.3% received a heart transplant. 84.6% of the patients live to this day. Conclusions Arrhythmogenic cardiomyopathy predominantly affected the young and male population. All the patients had a potentially fatal ventricular arrhythmia. Biventricular disease by echocardiography and cardiac magnetic resonance occurred in 69.2% and 100% of the cases, respectively. The therapeutic strategies used were antiarrhythmic medical treatment, placement of an ICD as secondary prevention, ablation, and heart transplantation. To date, 84.6% of patients survive.
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Affiliation(s)
- Rocío Huerta Robles
- Servicio de Cardiología Clínica. Instituto Nacional Cardiovascular INCOR - EsSalud. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCOR - EsSaludLimaPerú
| | - Francisco Chávez Solsol
- Servicio de Cardiología Clínica. Instituto Nacional Cardiovascular INCOR - EsSalud. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCOR - EsSaludLimaPerú
| | - Juan Muñoz Moreno
- Servicio de Cardiología Clínica. Instituto Nacional Cardiovascular INCOR - EsSalud. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCOR - EsSaludLimaPerú
| | - Diego Ortecho Llanos
- Servicio de Cardiología Clínica. Instituto Nacional Cardiovascular INCOR - EsSalud. Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCOR - EsSaludLimaPerú
| | - Mario Cabrera Saldaña
- Servicio de Electrofisiología. Instituto Nacional Cardiovascular INCOR - EsSalud. Lima, PerúLimaPerú
| | - Zoila Rodríguez Urteaga
- Servicio de Ayuda al Diagnóstico y Tratamiento. Instituto Nacional Cardiovascular INCOR- EsSalud, Lima, PerúLimaPerú
| | - Marco Gutiérrez Garibay
- Servicio de Cardiología no Invasiva. Instituto Nacional Cardiovascular INCOR- EsSalud. Lima, Perú.LimaPerú
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Sinagra G, Cappelletto C, DE Luca A, Romani S, Paldino A, Korcova R, Ferro MD, Vitrella G, Pagnan L, Pinamonti B. Focus on arrhythmogenic right ventricular cardiomyopathy. Eur Heart J Suppl 2020; 22:L129-L135. [PMID: 33239987 PMCID: PMC7673615 DOI: 10.1093/eurheartj/suaa152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy is a myocardial disease generally caused by desmosomal mutations and characterized by progressive replacement of cardiomyocites with fibro-adipose tissue. In the classic form of the disease right ventricle is predominantly affected. However, biventricular and left-dominant variants have been recently recognized, leading to the new nosological definition of arrhythmogenic cardiomyopathy. The condition affects mostly young adults and athletes and is clinically characterized by ventricular arrhythmias, heart failure and sudden cardiac death. The diagnosis is based on clinical-instrumental criteria, including family history, morpho-functional and electrocardiographic abnormalities, ventricular arrhythmias and genetic defects (Task Force Criteria, 2010). The main goal in the management of patients is the prevention of sudden cardiac death, where implantable cardioverter-defibrillator is the only effective therapeutic strategy. Many arrhythmic risk factors have been described. Recently, an on-line calculator has been proposed, but it needs further validation.
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Affiliation(s)
- Gianfranco Sinagra
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Chiara Cappelletto
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Antonio DE Luca
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Simona Romani
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Alessia Paldino
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Renata Korcova
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Matteo Dal Ferro
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Giancarlo Vitrella
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Lorenzo Pagnan
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
| | - Bruno Pinamonti
- Dipartimento Cardiotoracovascolare e Unità Clinico Operativa di Radiologia Diagnostica ed Interventistica; Azienda Sanitaria Universitaria Giuliano Isontina, Università degli Studi di Trieste
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Corrado D, Perazzolo Marra M, Zorzi A, Beffagna G, Cipriani A, Lazzari MD, Migliore F, Pilichou K, Rampazzo A, Rigato I, Rizzo S, Thiene G, Anastasakis A, Asimaki A, Bucciarelli-Ducci C, Haugaa KH, Marchlinski FE, Mazzanti A, McKenna WJ, Pantazis A, Pelliccia A, Schmied C, Sharma S, Wichter T, Bauce B, Basso C. Diagnosis of arrhythmogenic cardiomyopathy: The Padua criteria. Int J Cardiol 2020; 319:106-114. [DOI: 10.1016/j.ijcard.2020.06.005] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/16/2022]
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Leopoulou M, Mattsson G, LeQuang JA, Pergolizzi JV, Varrassi G, Wallhagen M, Magnusson P. Naxos disease - a narrative review. Expert Rev Cardiovasc Ther 2020; 18:801-808. [PMID: 32966140 DOI: 10.1080/14779072.2020.1828064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Naxos disease is a rare entity that manifests with woolly hair, keratosis of extremities, and cardiac manifestations that resemble arrhythmogenic right ventricular cardiomyopathy. It is inherited in an autosomal recessive pattern and mutations affecting plakoglobin and desmoplakin have been identified. There is an increased risk of arrhythmias, including sudden cardiac death at a young age. Right ventricular systolic dysfunction often progresses and left ventricular involvement may also occur. AREAS COVERED This article reviews historic background, epidemiology, clinical characteristics, genetics, and pathogenesis as well as therapeutic management and future perspectives. EXPERT OPINION The principles of evaluation and treatment are based on arrhythmogenic right ventricular cardiomyopathy (ARVC) and general heart failure guidelines, because specific data on Naxos disease are limited. Therefore, larger registries on Naxos disease are welcome in order to gain more knowledge about clinical course and risk stratification. Translational research on pathophysiological mechanisms has evolved, including promising approaches using stem cells for novel targets.
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Affiliation(s)
| | - Gustav Mattsson
- Centre for Research and Development, Uppsala University/Region Gävleborg , Gävle, Sweden
| | | | - Joseph V Pergolizzi
- NEMA Research, Inc , Naples, Florida, USA.,Native Cardio, Inc , Naples, Florida, USA
| | - Giustino Varrassi
- Paolo Procacci Foundation , Rome, Italy.,President, World Institute of Pain , California, USA
| | - Marita Wallhagen
- Faculty of Engineering and Sustainable Development, University of Gävle , Gävle, Sweden
| | - Peter Magnusson
- Centre for Research and Development, Uppsala University/Region Gävleborg , Gävle, Sweden.,Cardiology Research Unit, Department of Medicine, Karolinska Institutet , Stockholm, Sweden
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Cavigli L, Focardi M, Cameli M, Mandoli GE, Mondillo S, D'Ascenzi F. The right ventricle in “Left-sided” cardiomyopathies: The dark side of the moon. Trends Cardiovasc Med 2020; 31:476-484. [DOI: 10.1016/j.tcm.2020.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
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Aquaro GD, De Luca A, Cappelletto C, Raimondi F, Bianco F, Botto N, Barison A, Romani S, Lesizza P, Fabris E, Todiere G, Grigoratos C, Pingitore A, Stolfo D, Dal Ferro M, Merlo M, Di Bella G, Sinagra G. Comparison of different prediction models for the indication of implanted cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy. ESC Heart Fail 2020; 7:4080-4088. [PMID: 32965795 PMCID: PMC7755004 DOI: 10.1002/ehf2.13019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 01/07/2023] Open
Abstract
Aims Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a high risk of sudden cardiac death. Three different prediction models for the indication of implanted cardioverter defibrillator (ICD) are now available: the 5 year ARVC risk score, the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. We compared these three prediction models in a validation cohort of patients with definite ARVC. Methods and results In a cohort of 140 patients with definite ARVC, the 5 year ARVC risk score and the ITFC and HRS criteria were compared for the prediction of a major combined endpoint of sudden cardiac death, appropriate ICD intervention, resuscitated cardiac arrest, and sustained ventricular tachycardia. During the follow‐up, 65 major events occurred. The 5 year ARVC risk score with a threshold >10%, derived from the maximally selected rank statistic, predicted 62 (95%) events [odds ratio (OR) 9.1, 95% confidence interval (CI) 2.6–32, P = 0.0006], the ITFC criteria 53 (81%, OR 4.8, 95% CI 2.2–10.3, P = 0.0001), and the HRS criteria 29 (45%, OR 4.2, 95% CI 1.9–9.3, P = 0.0003). At the analysis of decision curve for ICD implantation, a 5 year ARVC risk score >10% showed a greater net benefit than the ITFC and HRS criteria over a wide range of threshold probability of events. Finally, at multivariate analysis, the 5 year ARVC risk score >10% was the only independent predictor of major events. Conclusions The 5 year score with a threshold of >10% was more effective for predicting events than the ITFC and HRS criteria.
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Affiliation(s)
| | - Antonio De Luca
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Chiara Cappelletto
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | | | - Francesco Bianco
- Institute of Cardiology, 'G. d'Annunzio' University, Chieti, Italy
| | - Nicoletta Botto
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy
| | - Andrea Barison
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy
| | - Simona Romani
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Pierluigi Lesizza
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Enrico Fabris
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Giancarlo Todiere
- Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, Pisa, 56124, Italy
| | | | | | - Davide Stolfo
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Matteo Dal Ferro
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | - Marco Merlo
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
| | | | - Gianfranco Sinagra
- Cardio-thoraco-vascular Department, University of Trieste, Trieste, Italy
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Arrhythmic risk stratification by cardiac magnetic resonance tissue characterization: disclosing the arrhythmic substrate within the heart muscle. Heart Fail Rev 2020; 27:49-69. [PMID: 32564329 DOI: 10.1007/s10741-020-09986-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sudden cardiac death (SCD) is a pivotal health problem worldwide. The identification of subjects at increased risk of SCD is crucial for the accurate selection of candidates for implantable cardioverter defibrillator (ICD) therapy. Current strategies for arrhythmic stratification largely rely on left ventricular (LV) ejection fraction (EF), mostly measured by echocardiography, and New York Heart Association functional status for heart failure with reduced EF. For specific diseases, such as hypertrophic and arrhythmogenic cardiomyopathy, some risk scores have been proposed; however, these scores take into account some parameters that are a partial reflection of the global arrhythmic risk and show a suboptimal accuracy. Thanks to a more comprehensive evaluation, cardiac magnetic resonance (CMR) provides insights into the heart muscle (the so-called tissue characterization) identifying cardiac fibrosis as an arrhythmic substrate. Combining sequences before and after administration of contrast media and mapping techniques, CMR is able to characterize the myocardial tissue composition, shedding light on both intracellular and extracellular alterations. Over time, late gadolinium enhancement (LGE) emerged as solid prognostic marker, strongly associated with major arrhythmic events regardless of LVEF, adding incremental value over current strategy in ischemic heart disease and non-ischemic cardiomyopathies. The evidence on a potential prognostic role of mapping imaging is promising. However, mapping techniques require further investigation and standardization. Disclosing the arrhythmic substrate within the myocardium, CMR should be considered as part of a multiparametric approach to personalized arrhythmic stratification.
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Prognostic Value of Magnetic Resonance Phenotype in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. J Am Coll Cardiol 2020; 75:2753-2765. [DOI: 10.1016/j.jacc.2020.04.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/20/2022]
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D'Ascenzi F, Solari M, Corrado D, Zorzi A, Mondillo S. Diagnostic Differentiation Between Arrhythmogenic Cardiomyopathy and Athlete's Heart by Using Imaging. JACC Cardiovasc Imaging 2019; 11:1327-1339. [PMID: 30190032 DOI: 10.1016/j.jcmg.2018.04.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden cardiac death (SCD) in youth and athletes. In the last decade, several studies focused on right ventricular (RV) remodeling in athletes and revealed that features of the physiological adaptation of the right heart to training, such as RV dilation, may overlap with those of ARVC. Therefore, a careful multiparametric evaluation is required for differential diagnosis in order to avoid false diagnosis of ARVC or, in contrast, fail to identify the risk of causing SCD. This review summarizes physiological adaptation of the RV to exercise and describes features that could help distinguishing between athlete's heart and ARVC.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Marco Solari
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Wang W, James CA, Calkins H. Diagnostic and therapeutic strategies for arrhythmogenic right ventricular dysplasia/cardiomyopathy patient. Europace 2019; 21:9-21. [PMID: 29688316 PMCID: PMC6321962 DOI: 10.1093/europace/euy063] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/16/2018] [Indexed: 12/21/2022] Open
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a rare inherited heart muscle disease characterized by ventricular tachyarrhythmia, predominant right ventricular dysfunction, and sudden cardiac death. Its pathophysiology involves close interaction between genetic mutations and exposure to physical activity. Mutations in genes encoding desmosomal protein are the most common genetic basis. Genetic testing plays important roles in diagnosis and screening of family members. Syncope, palpitation, and lightheadedness are the most common symptoms. The 2010 Task Force Criteria is the standard for diagnosis today. Implantation of a defibrillator in high-risk patients is the only therapy that provides adequate protection against sudden death. Selection of patients who are best candidates for defibrillator implantation is challenging. Exercise restriction is critical in affected individuals and at-risk family members. Antiarrhythmic drugs and ventricular tachycardia ablation are valuable but palliative components of the management. This review focuses on the current diagnostic and therapeutic strategies in ARVD/C and outlines the future area of development in this field.
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Affiliation(s)
- Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
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Aquaro GD, Pingitore A, Di Bella G, Piaggi P, Gaeta R, Grigoratos C, Altinier A, Pantano A, Strata E, De Caterina R, Sinagra G, Emdin M. Prognostic Role of Cardiac Magnetic Resonance in Arrhythmogenic Right Ventricular Cardiomyopathy. Am J Cardiol 2018; 122:1745-1753. [PMID: 30220419 DOI: 10.1016/j.amjcard.2018.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022]
Abstract
We sought to evaluate the prognostic role of cardiac magnetic resonance (CMR) in patients with definite, borderline and possible diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) as defined by the International Task Force (TF) in 2010. CMR was performed in 175 patients: 52 with definite, 50 with borderline and 73 possible ARVC. Abnormal-CMR was defined as the presence of ≥1 CMR abnormalities (including abnormalities of right ventricular and left ventricular wall motion, fat infiltration, late gadolinium enhancement, dilation and dysfunction of either ventricles). During the follow-up time 35 patients had hard cardiac events (sudden cardiac death, appropriate implantable cardioverter defibrillator shock and resuscitated cardiac arrest), and 34 of them occurred in patients with abnormal-CMR (negative predictive value = 96.9%). At the multivariate Cox-regression analysis LV involvement at CMR (fat infiltration and/or late gadolinium enhancement), and episode of nonsustained ventricular tachycardia (NSVT) were independent predictors of cardiac events in both the whole population (LV involvement: HR 3.69, 95% CI 1.57-8.65, p = 0.0002; NSVT: HR 5.8, 95% CI 2.82-11.9, p < 0.0001), and in the group of patients with definite ARVC (LV involvement: HR 3.03, 95% CI 1.15 to 8.02, p = 0.02; NSVT: HR 12.1, 95% CI 4.02-36.5, p < 0.0001). In conclusion, CMR evidence of LV involvement is a strong independent predictor of cardiac events in patients with definite, borderline or possible ARVC diagnosis. Abnormal CMR has very high negative predictive value for hard cardiac events.
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Affiliation(s)
| | | | - Gianluca Di Bella
- Clinical and Experimental Department of Medicine. University of Messina, Messina, Italy
| | - Paolo Piaggi
- Department of Energy and Systems Engineering, University of Pisa, Pisa, Italy
| | | | | | | | | | | | | | | | - Michele Emdin
- G. Monasterio CNR-Tuscany Foundation, Pisa, Italy; Scuola Universitaria Superiore Sant'Anna, Pisa, Italy
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Cho Y. Arrhythmogenic right ventricular cardiomyopathy. J Arrhythm 2018; 34:356-368. [PMID: 30167006 PMCID: PMC6111474 DOI: 10.1002/joa3.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive cardiomyopathy characterized by fibrofatty infiltration of the myocardium, ventricular arrhythmias, sudden death, and heart failure. ARVC may be an important cause of syncope, sudden death, ventricular arrhythmias, and/or wall motion abnormalities, especially in the young. As the first symptom is sudden death or cardiac arrest in many cases, an early diagnosis and risk stratification are important. Recent advances in diagnostic modalities will be helpful in the early diagnosis and proper management of patients at risk. Restriction of strenuous exercise and implantation of implantable cardioverter-defibrillators are important in addition to medical treatment and catheter ablation of ventricular tachycardia. Recently introduced genetic screening may help to identify asymptomatic carriers with a risk of a disease progression and sudden death.
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Affiliation(s)
- Yongkeun Cho
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
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Xie S, Desjardins B, Kubala M, Liang J, Yang J, van der Geest RJ, Schaller R, Riley M, Callans D, Zado E, Marchlinski F, Nazarian S. Association of regional epicardial right ventricular electrogram voltage amplitude and late gadolinium enhancement distribution on cardiac magnetic resonance in patients with arrhythmogenic right ventricular cardiomyopathy: Implications for ventricular tachycardia ablation. Heart Rhythm 2018; 15:987-993. [PMID: 29501666 DOI: 10.1016/j.hrthm.2018.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Criteria for identification of anatomic ventricular tachycardia substrates in arrhythmogenic right ventricular cardiomyopathy (ARVC) on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) are unclear. OBJECTIVE The purpose of this study was to define (1) the association of regional right ventricular (RV) epicardial voltage amplitude with the distribution of LGE; and (2) appropriate image signal intensity (SI) thresholds for ventricular tachycardia substrate identification in ARVC. METHODS Preprocedural LGE-CMR and epicardial electrogram mapping were performed in 10 ARVC patients. The locations of epicardial electrogram map points, obtained during sinus rhythm with intrinsic conduction or RV pacing, were retrospectively registered to the corresponding LGE image regions. Standardized SI z-scores (standard deviation distance from the mean) were calculated for each 10-mm region surrounding map points. RESULTS In patient-clustered, generalized estimating equations models that included 3205 epicardial electroanatomic points and corresponding SI measures, bipolar (-1.43 mV/z-score; P <.001) and unipolar voltage amplitude (-1.22 mV/z-score; P <.001) were associated with regional SI z-scores. In contrast to the QRS-late potential (LP) interval (P = .362), the LP activation index, defined as electrogram duration divided by QRS-LP, was associated with regional SI z-scores (P <.001). SI z-score thresholds >0.05 (95% confidence interval -0.05 to 0.15) and <-0.16 (95% confidence interval -0.26 to 0.06) corresponded to bipolar voltage measures <0.5 and >1.0 mV, respectively. CONCLUSION Increased RV gadolinium uptake is associated with lower epicardial bipolar and unipolar electrogram voltage amplitude. Standardized LGE-CMR SI z-scores may augment preprocedural planning for identification of low-voltage zones and abnormal myocardium in ARVC.
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Affiliation(s)
- Shuanglun Xie
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Benoit Desjardins
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Maciej Kubala
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jackson Liang
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jiandu Yang
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Centre, Leiden, The Netherlands
| | - Robert Schaller
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael Riley
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David Callans
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Erica Zado
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Francis Marchlinski
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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Li KHC, Bazoukis G, Liu T, Li G, Wu WKK, Wong SH, Wong WT, Chan YS, Wong MCS, Wassilew K, Vassiliou VS, Tse G. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) in clinical practice. J Arrhythm 2018; 34:11-22. [PMID: 29721109 PMCID: PMC5828272 DOI: 10.1002/joa3.12021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited myocardial disease characterized by fibro-fatty replacement of the right ventricular myocardium, and associated with paroxysmal ventricular arrhythmias and sudden cardiac death (SCD). It is currently the second most common cause of SCD after hypertrophic cardiomyopathy in young people <35 years of age, causing up to 20% of deaths in this patient population. This condition has a male preponderance and is more commonly found in individuals of Italian and Greek descent. To date, there is no single diagnostic test for ARVC/D and the diagnosis is made based on clinical, electrocardiographic, and radiological findings according to the Revised 2010 Task Force Criteria. In this review, we will discuss the mainstay treatment which includes pharmacotherapy, implantable cardioverter-defibrillator insertion for abortion of sudden cardiac death, and in the advanced stages of the disease cardiac transplantation.
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Affiliation(s)
| | - George Bazoukis
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Guangping Li
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - William K. K. Wu
- Department of Anaesthesia and Intensive CareFaculty of MedicineChinese University of Hong KongHong KongChina
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Sunny Hei Wong
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Wing Tak Wong
- School of Life SciencesChinese University of Hong KongHong KongChina
| | - Yat Sun Chan
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary CareFaculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Katharina Wassilew
- Department of PathologyRigshospitaletUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Vassilios S. Vassiliou
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Royal Brompton Hospital and Imperial College LondonLondonUK
| | - Gary Tse
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
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