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Cianci V, Forzese E, Sapienza D, Cianci A, Ieni A, Germanà A, Guerrera MC, Omero F, Speranza D, Cracò A, Asmundo A, Gualniera P, Mondello C. Arrhythmogenic Right Ventricular Cardiomyopathy Post-Mortem Assessment: A Systematic Review. Int J Mol Sci 2024; 25:2467. [PMID: 38473714 PMCID: PMC10931616 DOI: 10.3390/ijms25052467] [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: 01/27/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterized by the progressive fibro-fatty replacement of the right ventricular myocardium, leading to myocardial atrophy. Although the structural changes usually affect the right ventricle, the pathology may also manifest with either isolated left ventricular myocardium or biventricular involvement. As ARVC shows an autosomal dominant pattern of inheritance with variable penetrance, the clinical presentation of the disease is highly heterogeneous, with different degrees of severity and patterns of myocardial involvement even in patients of the same familiar group with the same gene mutation: the pathology spectrum ranges from the absence of symptoms to sudden cardiac death (SCD) sustained by ventricular arrhythmias, which may, in some cases, be the first manifestation of an otherwise silent pathology. An evidence-based systematic review of the literature was conducted to evaluate the state of the art of the diagnostic techniques for the correct post-mortem identification of ARVC. The research was performed using the electronic databases PubMed and Scopus. A methodological approach to reach a correct post-mortem diagnosis of ARVC was described, analyzing the main post-mortem peculiar macroscopic, microscopic and radiological alterations. In addition, the importance of performing post-mortem genetic tests has been underlined, which may lead to the correct identification and characterization of the disease, especially in those ARVC forms where anatomopathological investigation does not show evident morphostructural damage. Furthermore, the usefulness of genetic testing is not exclusively limited to the correct diagnosis of the pathology, but is essential for promoting targeted screening programs to the deceased's family members. Nowadays, the post-mortem diagnosis of ARVC performed by forensic pathologist remains very challenging: therefore, the identification of a clear methodological approach may lead to both a reduction in under-diagnoses and to the improvement of knowledge on the disease.
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Affiliation(s)
- Vincenzo Cianci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Elena Forzese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Alessio Cianci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, Section of Pathology, University of Messina, 98125 Messina, Italy;
| | - Antonino Germanà
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, Via Palatucci Snc, University of Messina, 98168 Messina, Italy; (A.G.); (M.C.G.)
| | - Maria Cristina Guerrera
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, Via Palatucci Snc, University of Messina, 98168 Messina, Italy; (A.G.); (M.C.G.)
| | - Fausto Omero
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98125 Messina, Italy; (F.O.); (D.S.)
| | - Desirèe Speranza
- Medical Oncology Unit, Department of Human Pathology “G.Barresi”, University of Messina, 98125 Messina, Italy; (F.O.); (D.S.)
| | - Annalisa Cracò
- Department of Biomedical Sciences and Morphological and Functional Imaging, Diagnostic and Interventional Radiology Unit, University Hospital Messina, 98125 Messina, Italy;
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy; (E.F.); (D.S.); (A.A.); (P.G.); (C.M.)
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Khan Z, Abumedian M, Yousif Y, Gupta A, Myo SL, Mlawa G. Arrhythmogenic Right Ventricular Cardiomyopathy in a Patient Experiencing Out-of-Hospital Ventricular Fibrillation Arrest Twice: Case Report and Review of the Literature. Cureus 2022; 14:e21457. [PMID: 35223241 PMCID: PMC8857986 DOI: 10.7759/cureus.21457] [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] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
We present a case of a 62-year-old male who was admitted to the hospital with out-of-hospital ventricular fibrillation (VF) arrest. He had a VF arrest in 2011 and was admitted to another hospital. He had several investigations excluding cardiac magnetic resonance imaging, all of which were normal. He was playing tennis on both occasions when he experienced the VF arrest. His electrocardiogram on admission showed AF with partial right bundle branch block, inverted T waves in V1-V2, low voltage QRS complexes, ventricular ectopic in lead V1-V2, and prolonged QTc. His echocardiogram showed normal left ventricular function and a dilated right ventricle. Cardiac magnetic resonance imaging showed a dilated RV cavity size with impaired systolic function and dyskinetic region in the mid-ventricular free wall proximal to the insertion of the moderator band and late gadolinium enhancement in both right and left ventricles insertion points and mid-wall late gadolinium enhancement in the basal inferolateral wall suggestive of arrhythmogenic right ventricular cardiomyopathy. He had a single chamber VVI implantable cardioverter-defibrillator fitted for primary prevention and was discharged home. He had outpatient follow-up and showed good improvement and his implantable cardioverter-defibrillator checks were satisfactory and did not experience any shocks.
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Asher C, Thomas T, Rinaldi CA, Carr‐White G. A case of mistaken arrhythmogenic identity during pregnancy. Clin Case Rep 2021; 9:e04561. [PMID: 34386235 PMCID: PMC8344966 DOI: 10.1002/ccr3.4561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 11/26/2022] Open
Abstract
Atypical LVOT ectopy can present with an RVOT morphology on ECG and differentiation to reveal this focus is in favor of benign idiopathic ventricular ectopy over an arrhythmogenic cardiomyopathy.
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Affiliation(s)
- Clint Asher
- School of Biomedical Engineering and Imaging SciencesRayne InstituteKing’s College LondonSt Thomas HospitalLondonUK
- Department of CardiologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Tessa Thomas
- Department of Acute MedicineMaidstone and Tunbridge Wells NHS TrustKentUK
| | - Christopher A. Rinaldi
- School of Biomedical Engineering and Imaging SciencesRayne InstituteKing’s College LondonSt Thomas HospitalLondonUK
- Department of CardiologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
| | - Gerry Carr‐White
- School of Biomedical Engineering and Imaging SciencesRayne InstituteKing’s College LondonSt Thomas HospitalLondonUK
- Department of CardiologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
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Wichter T, Milberg P, Wichter HD, Dechering DG. Pregnancy in arrhythmogenic cardiomyopathy. Herzschrittmacherther Elektrophysiol 2021; 32:186-198. [PMID: 34032905 PMCID: PMC8166670 DOI: 10.1007/s00399-021-00770-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
Arrhythmogenic cardiomyopathy (AC) is a rare heart muscle disease with a genetic background and autosomal dominant mode of transmission. The clinical manifestation is characterized by ventricular arrhythmias (VA), heart failure (HF) and the risk of sudden cardiac death (SCD). Pregnancy in young female patients with AC represents a challenging condition for the life and family planning of young affected women. In addition to genetic mechanisms that influence the complex pathophysiology of AC, experimental and clinical data have confirmed the pathogenetic role of strenuous exercise and competitive sports in the early onset and rapid progression of AC symptoms and complications. Pregnancy and exercise share a number of physiological aspects of adaptation. In AC, both result in ventricular volume overload and myocardial stretch. Therefore, pregnancy has been postulated as a potential risk factor for HF, VA, SCD, and pregnancy-related obstetric complications in patients with AC. However, the available evidence on pregnancy in AC does not confirm this hypothesis. In most women with AC, pregnancies are well tolerated, uneventful, and follow a benign course. Pregnancy-related symptoms (VA, syncope, HF) and mortality, as well as obstetric complications, are uncommon in AC patients and range in the order of background populations and cohorts with AC and no pregnancy. The number of completed pregnancies is not associated with an acceleration of AC pathology or an increased risk of VA or HF during pregnancy and follow-up. Accordingly, there is no medical indication to advise against pregnancy in patients with AC. Preconditions include stability of rhythm and hemodynamics at baseline, as well as clinical follow-ups and the availability of multidisciplinary expert consultation during pregnancy and postpartum. Genetic counseling is recommended prior to pregnancy for all couples and their families affected by AC.
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Affiliation(s)
- Thomas Wichter
- Klinik für Innere Medizin / Kardiologie, Niels-Stensen-Kliniken, Marienhospital Osnabrück, Herzzentrum Osnabrück/Bad Rothenfelde, Bischofsstr. 1, 49074, Osnabrück, Germany.
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Tarantino N, Della Rocca DG, De Leon De La Cruz NS, Manheimer ED, Magnocavallo M, Lavalle C, Gianni C, Mohanty S, Trivedi C, Al-Ahmad A, Horton RP, Bassiouny M, Burkhardt JD, Gallinghouse GJ, Forleo GB, Di Biase L, Natale A. Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:205. [PMID: 33652714 PMCID: PMC7996951 DOI: 10.3390/medicina57030205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/22/2022]
Abstract
A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete's age, and the operator's expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.
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Affiliation(s)
- Nicola Tarantino
- Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA; (N.T.); (E.D.M.); (L.D.B.)
| | - Domenico G. Della Rocca
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | | | - Eric D. Manheimer
- Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA; (N.T.); (E.D.M.); (L.D.B.)
| | - Michele Magnocavallo
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (M.M.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (M.M.); (C.L.)
| | - Carola Gianni
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Sanghamitra Mohanty
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Chintan Trivedi
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Amin Al-Ahmad
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Rodney P. Horton
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Mohamed Bassiouny
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - J. David Burkhardt
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - G. Joseph Gallinghouse
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Giovanni B. Forleo
- Department of Cardiology, Azienda Ospedaliera-Universitaria “Luigi Sacco”, 20057 Milano, Italy;
| | - Luigi Di Biase
- Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA; (N.T.); (E.D.M.); (L.D.B.)
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Andrea Natale
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
- Interventional Electrophysiology, Scripps Clinic, La Jolla, CA 92037, USA
- Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Shaboodien G, Spracklen TF, Kamuli S, Ndibangwi P, Van Niekerk C, Ntusi NAB. Genetics of inherited cardiomyopathies in Africa. Cardiovasc Diagn Ther 2020; 10:262-278. [PMID: 32420109 DOI: 10.21037/cdt.2019.10.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCDs) is rising disproportionately in comparison to the rest of the world, affecting urban, semi-urban and rural dwellers alike. NCDs are predicted to surpass infections like human immunodeficiency virus, tuberculosis and malaria as the leading cause of mortality in SSA over the next decade. Heart failure (HF) is the dominant form of cardiovascular disease (CVD), and a leading cause of NCD in SSA. The main causes of HF in SSA are hypertension, cardiomyopathies, rheumatic heart disease, pericardial disease, and to a lesser extent, coronary heart disease. Of these, the cardiomyopathies deserve greater attention because of the relatively poor understanding of mechanisms of disease, poor outcomes and the disproportionate impact they have on young, economically active individuals. Morphofunctionally, cardiomyopathies are classified as dilated, hypertrophic, restrictive and arrhythmogenic; regardless of classification, at least half of these are inherited forms of CVD. In this review, we summarise all studies that have investigated the incidence of cardiomyopathy across Africa, with a focus on the inherited cardiomyopathies. We also review data on the molecular genetic underpinnings of cardiomyopathy in Africa, where there is a striking lack of studies reporting on the genetics of cardiomyopathy. We highlight the impact that genetic testing, through candidate gene screening, association studies and next generation sequencing technologies such as whole exome sequencing and targeted resequencing has had on the understanding of cardiomyopathy in Africa. Finally, we emphasise the need for future studies to fill large gaps in our knowledge in relation to the genetics of inherited cardiomyopathies in Africa.
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Affiliation(s)
- Gasnat Shaboodien
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Timothy F Spracklen
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen Kamuli
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Polycarp Ndibangwi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carla Van Niekerk
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Effect of Pregnancy in Arrhythmogenic Right Ventricular Cardiomyopathy. Am J Cardiol 2020; 125:613-617. [PMID: 31836129 DOI: 10.1016/j.amjcard.2019.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 11/22/2022]
Abstract
Less is known about pregnancy in women with arrhythmogenic right ventricular cardiomyopathy (ARVC). From April 1995 to May 2018, 157 women with ARVC were retrospectively enrolled. Data on pregnancy and cardiac outcomes were analyzed. There were 224 pregnancies in 120 patients including 30 (13.4%) spontaneous and 2 (0.9%) medical abortions, 12 cardiac adverse events were recorded including new onset frequent premature ventricular contractions (PVC) in 3 (2.5%) patients, previous PVC numbers increased more than 100% in 5 (4.2%), syncope in 2 (1.7%), sustained ventricular tachycardia and heart failure required hospitalization each in one patient (0.8%). Women with cardiac events showed lower left ventricular ejection fraction (LVEF) (50.3 ± 2.7 vs 60.0 ± 7.3; p = 0.004). No significant change in cardiac structure and function was found at 1 year follow-up postpartum. At a median follow-up of 8 (1 to 32) years, 36 (22.9%) women died. Earlier symptom onset age (hazard ratio 1.046; 95% confidence interval 1.017 to 1.075; p = 0.002) and decreased LVEF (hazard ratio 1.127; 95% confidence interval 1.001 to 1.154; p = 0.041) increased the risk of all-cause mortality, pregnancy had no negative influence on survival. In all the 192 offsprings (mean age 26.3 ± 13.5 years), 2 died of sudden death, no definite ARVC was found. Pregnancy seemed to be acceptable in ARVC, decreased LVEF increased the risk of pregnancy and was associated with poorer long-term survival.
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Cardiac magnetic resonance based deformation imaging: role of feature tracking in athletes with suspected arrhythmogenic right ventricular cardiomyopathy. Int J Cardiovasc Imaging 2018; 35:529-538. [PMID: 30382474 PMCID: PMC6453871 DOI: 10.1007/s10554-018-1478-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/16/2018] [Indexed: 12/17/2022]
Abstract
Both, arrhythmogenic right ventricular cardiomyopathy (ARVC) and regular training are associated with right ventricular (RV) remodelling. Cardiac magnetic resonance (CMR) is given an important role in the diagnosis of ARVC in current task force criteria (TFC), however, they contain no cut-off values for athletes. We aimed to confirm the added value of feature tracking and to provide new cut-off values to differentiate between ARVC and athlete's heart. Healthy athletes with training of minimal 15 h/week (n = 34), patients with definite ARVC (n = 34) and highly trained athletes with ARVC (n = 8) were examined by CMR. Left and right ventricular volumes and masses were determined. Global right and left ventricular, and regional strain analysis for the RV free wall was performed using feature tracking on balanced steady-state free precession cine images. 94% of healthy athletes showed RV dilatation of the proposed TFC, 14.7% showed RV ejection fraction (RVEF) between 45-50%, none of them had RVEF < 45%. Although RVEF showed the highest accuracy in differentiating between athlete's heart and ARVC, only 37.5% of athletes with ARVC showed RVEF < 45%. The only parameters falling in the pathological range (based on our established cut-off values: > - 25.6 and > - 1.4, respectively) in all athletes with ARVC were the strain and strain rate of the midventricular RV free wall. Establishing RVEF and RV strain analysis provides an important tool to distinguish ARVC from athlete's heart. CMR based regional strain and strain rate values may help to identify ARVC even in highly trained athletes with preserved RVEF.
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