1
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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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2
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Haliot K, Dubes V, Constantin M, Pernot M, Labrousse L, Busuttil O, Walton RD, Bernus O, Rogier J, Nubret K, Dos Santos P, Benoist D, Haïssaguerre M, Magat J, Quesson B. A 3D high resolution MRI method for the visualization of cardiac fibro-fatty infiltrations. Sci Rep 2021; 11:9266. [PMID: 33927217 PMCID: PMC8084928 DOI: 10.1038/s41598-021-85774-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
Modifications of the myocardial architecture can cause abnormal electrical activity of the heart. Fibro-fatty infiltrations have been implicated in various cardiac pathologies associated with arrhythmias and sudden cardiac death, such as arrhythmogenic right ventricular cardiomyopathy (ARVC). Here, we report the development of an MRI protocol to observe these modifications at 9.4 T. Two fixed ex vivo human hearts, one healthy and one ARVC, were imaged with an Iterative decomposition with echo asymmetry and least-square estimations (IDEAL) and a magnetization transfer (MT) 3D sequences. The resulting fat fraction and MT ratio (MTR) were analyzed and compared to histological analysis of the three regions (“ARVC triangle”) primarily involved in ARVC structural remodeling. In the ARVC heart, high fat content was observed in the “ARVC triangle” and the superimposition of the MTR and fat fraction allowed the identification of fibrotic regions in areas without the presence of fat. The healthy heart exhibited twice less fat than the ARVC heart (31.9%, 28.7% and 1.3% of fat in the same regions, respectively). Localization of fat and fibrosis were confirmed by means of histology. This non-destructive approach allows the investigation of structural remodeling in human pathologies where fibrosis and/or fatty tissue infiltrations are expected to occur.
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Affiliation(s)
- K Haliot
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France. .,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France. .,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.
| | - V Dubes
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - M Constantin
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - M Pernot
- Bordeaux University Hospital (CHU), 33600, Pessac, France
| | - L Labrousse
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Bordeaux University Hospital (CHU), 33600, Pessac, France
| | - O Busuttil
- Bordeaux University Hospital (CHU), 33600, Pessac, France
| | - R D Walton
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - O Bernus
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - J Rogier
- Bordeaux University Hospital (CHU), 33600, Pessac, France
| | - K Nubret
- Bordeaux University Hospital (CHU), 33600, Pessac, France
| | - P Dos Santos
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,Bordeaux University Hospital (CHU), 33600, Pessac, France
| | - D Benoist
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - M Haïssaguerre
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,Bordeaux University Hospital (CHU), 33600, Pessac, France
| | - J Magat
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France
| | - B Quesson
- IHU L'Institut de RYthmologie et de Modélisation Cardiaque (LIRYC), Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, 33600, Pessac-Bordeaux, France.,Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France.,INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33000, Bordeaux, France
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3
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Arrhythmogenic Left Ventricular Cardiomyopathy: A Clinical and CMR Study. Sci Rep 2020; 10:533. [PMID: 31953454 PMCID: PMC6969116 DOI: 10.1038/s41598-019-57203-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022] Open
Abstract
The clinical features, CMR characteristics and outcomes of arrhythmogenic left ventricular cardiomyopathy (ALVC), which is a very rare nonischemic cardiomyopathy, are currently not well studied. The purpose of the study is to investigate the clinical and cardiovascular magnetic resonance (CMR) imaging characteristics of arrhythmogenic left ventricular cardiomyopathy (ALVC). Fifty-three consecutive patients with ALVC were divided into two groups: ALVC patients without right ventricular (RV) involvement (n = 36, group 1) and those with RV involvement (n = 17, group 2). Clinical symptoms, cardiac electrophysiological findings, and CMR parameters (morphology, ventricular function, and myocardial fibrosis and fatty infiltration) were evaluated in both groups. The two groups showed no significant difference in age, gender, or presenting symptoms (P > 0.05). Right bundle branch block ventricular arrhythmia was less common in patients without RV involvement (50.0% vs.64.7%, P = 0.031). There were no significant differences in left ventricular function between the two groups, however right ventricular ejection fraction was significantly lower in group 2 (40.1 ± 4.0% vs. 48.7 ± 3.9%, P < 0.001). Inverse correlations of left ventricular ejection fraction with fat volume (r = −0.883, p = 0.001), late gadolinium enhancement (LGE) volume (r = −0.892, 0.013), ratio of fat/LGE (r = −0.848, p < 0.001), indexed left ventricular end diastolic volume (r = −0.877, p < 0.001) and indexed left ventricular end systolic volume (r = −0.943, p < 0.001) were all significant. ALVC is a rare disease with fibro-fatty replacement predominantly in the left ventricle, impaired left ventricular systolic function, and ventricular arrhythmias originating from the left ventricle. ALVC with right ventricular involvement may have a worse prognosis.
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4
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Bazoukis G, Letsas KP, Xia Y, Tse G, Li KHC. A novel desmin mutation causing severe left ventricular arrhythmogenic cardiomyopathy/dysplasia. J Thorac Dis 2018; 10:S3100-S3102. [PMID: 30370089 PMCID: PMC6186622 DOI: 10.21037/jtd.2018.07.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Affiliation(s)
- George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Konstantinos P. Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518000, China
| | - Ka Hou Christien Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Faculty of Medicine, Newcastle University, Newcastle, UK
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5
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Ali M, Bhat IA, Hafeez I, Dar MI, Beig JR, Shah ZA, Iqbal K. Clinical profile in arrhythmogenic cardiomyopathy and a recessive plakophilin-2 gene mutation. Indian Heart J 2018; 70:421-426. [PMID: 29961461 PMCID: PMC6034022 DOI: 10.1016/j.ihj.2017.10.010] [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: 05/27/2017] [Revised: 09/01/2017] [Accepted: 10/19/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Arrhythmogenic cardiomyopathy (ACM) is not an uncommon cause of cardiac morbidity in Kashmir valley. This study was designed to document various clinical features and to sequence exons 11 and 12 of plakophilin 2 (PKP2) gene in these patients. Methods ACM patients who attended cardiology outpatient department of our institute from January 2014 to April 2015 were included in the study. Their records were reviewed. Controls were randomly selected, who had no history or family history of cardiac illness and had a normal cardiac examination. A blood sample was also taken from both the groups for sequencing of exon 11 and 12 of PKP2 gene. ACM patients were followed up until July 2016. Results Eleven ACM patients and seven controls were included in the study. Most common mode of presentation was ventricular tachycardia (VT). Two patients had left ventricular (LV) systolic dysfunction. One patient had a splice site mutation in exon 12 of PKP2 gene and one patient died during follow-up. One of the controls had an intronic variation that has no pathogenic significance vis-à-vis ACM. Conclusion Our study describes various clinical parameters in ACM patients and a recessive plakophilin 2 mutation after a limited PKP2 gene sequencing.
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Affiliation(s)
- Muzaffar Ali
- Department of Cardiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K, India.
| | - Imtiyaz A Bhat
- Department of Immunology and Molecular Medicine Sheri Kashmir Institute of Medical Sciences, Srinagar, J&K, India
| | - Imran Hafeez
- Department of Cardiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
| | - Mohd Iqbal Dar
- Department of Cardiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
| | - Jahangir Rashid Beig
- Department of Cardiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
| | - Zafar Amin Shah
- Department of Immunology and Molecular Medicine Sheri Kashmir Institute of Medical Sciences, Srinagar, J&K, India
| | - Khurshid Iqbal
- Department of Cardiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, J&K, India
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6
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Hardebeck C, Wada A, Sofowora G. SPECT perfusion abnormality associated with arrhythmogenic right ventricular cardiomyopathy. J Nucl Cardiol 2018; 25:1044-1047. [PMID: 28097477 DOI: 10.1007/s12350-017-0783-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Charles Hardebeck
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
| | - Akira Wada
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Gbemiga Sofowora
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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7
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Cunningham SM, Sweeney JT, MacGregor J, Barton BA, Rush JE. Clinical Features of English Bulldogs with Presumed Arrhythmogenic Right Ventricular Cardiomyopathy: 31 Cases (2001–2013). J Am Anim Hosp Assoc 2018; 54:95-102. [DOI: 10.5326/jaaha-ms-6550] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden death in people and boxer dogs that has recently been described in English bulldogs. The objective of this retrospective study was to describe the clinical characteristics of English bulldogs with presumed ARVC. The medical records were searched for English bulldogs examined between 2001 and 2013 with a clinical diagnosis of ARVC. The average age of the 31 dogs identified was 9.2 ± 1.6 yr (range 7–13 yr). Males were overrepresented by a factor of 2.9 to 1. At initial presentation, 5 dogs had subclinical arrhythmia, 10 dogs had clinical signs attributable to arrhythmia, and 16 dogs had congestive heart failure. Eighteen dogs (58%) had ventricular tachycardia and five (16%) also had supraventricular arrhythmias. Four dogs experienced sudden death, 2 dogs died from congestive heart failure, 11 dogs were euthanized for cardiac causes, and 2 dogs died or were euthanized for noncardiac causes. Kaplan-Meier analysis showed a median survival time of 8.3 mo. This is the first study to describe the clinical characteristics of a population of English bulldogs with presumed ARVC. Further studies are needed to better characterize the clinical features of the disease in this breed.
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Affiliation(s)
- Suzanne M. Cunningham
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - Joseph T. Sweeney
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - John MacGregor
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - Bruce A. Barton
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - John E. Rush
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
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8
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Åström Aneq M, Maret E, Brudin L, Svensson A, Engvall J. Right ventricular systolic function and mechanical dispersion identify patients with arrhythmogenic right ventricular cardiomyopathy. Clin Physiol Funct Imaging 2017; 38:779-787. [PMID: 29105955 DOI: 10.1111/cpf.12479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/03/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE To assess right ventricular (RV) regional and global systolic function using feature tracking (FT) in patients with a definite diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) and to investigate if changes in strain amplitude and mechanical dispersion indicate a propensity for arrhythmia. MATERIALS AND METHODS Twenty-seven patients fulfilling Task Force Criteria for ARVC and 24 healthy volunteers underwent MR at 1·5 Tesla. Steady-state free precession cine of long-axis slices and a short-axis stack of the RV was acquired. Segmental longitudinal systolic strain amplitude and time-to-peak (TTP) strain were measured in the four- and two-chamber views of the RV. RESULTS Compared to controls, patients with ARVC had lower RV ejection fraction (RVEF), (53% vs 57%, P = 0·012) and lower longitudinal strain amplitude in the RV free wall (-20·6 vs -26·3%, P = 0·014) and in the basal part of the RV (-22·8 vs -31·7%, P<0·001). Mechanical dispersion, defined as the standard deviation (SD) of TTP of RV segments, was larger in patients with ARVC (48 ms [21-74] vs 35 ms [13-66 ms], P = 0·02). Patients with ventricular tachycardia (VT) or non-sustained VT had lower RVEF (46% vs 55%, P = 0·008), but did not have significantly lower RV strain amplitude (-19·5% vs 21·0%, P = 0·073) and no signs of mechanical dispersion (49 ms vs 48 ms, P = 0·861) compared to patients without arrhythmia. CONCLUSION ARVC patients had lower longitudinal absolute strain amplitude in basal RV segments and increased mechanical dispersion compared to healthy volunteers, but the presence of mechanical dispersion was not predictive of ventricular arrhythmia.
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Affiliation(s)
- Meriam Åström Aneq
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköpings Universitet, Linköping, Sweden
| | - Eva Maret
- Department of Clinical Physiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lars Brudin
- Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden
| | - Anneli Svensson
- Department of Cardiology and Department of Medical and Health Sciences, Linköpings Universitet, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköpings Universitet, Linköping, Sweden
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9
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Haugaa KH, Basso C, Badano LP, Bucciarelli-Ducci C, Cardim N, Gaemperli O, Galderisi M, Habib G, Knuuti J, Lancellotti P, McKenna W, Neglia D, Popescu BA, Edvardsen T. Comprehensive multi-modality imaging approach in arrhythmogenic cardiomyopathy-an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2017; 18:237-253. [PMID: 28069601 PMCID: PMC5837226 DOI: 10.1093/ehjci/jew229] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 12/29/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (AC) is a progressive disease with high risk of life-threatening ventricular arrhythmias. A genetic mutation is found in up to 50-60% of probands, mostly affecting desmosomal genes. Diagnosis of AC is made by a combination of data from different modalities including imaging, electrocardiogram, Holter monitoring, family history, genetic testing, and tissue properties. Being a progressive cardiomyopathy, repeated cardiac imaging is needed in AC patients. Repeated imaging is important also for risk assessment of ventricular arrhythmias. This expert consensus document gives clinical recommendations for how to use multi-modality imaging in the different aspects of AC disease, including diagnosis, family screening, follow-up, risk assessment, and differential diagnosis.
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Affiliation(s)
- Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo and University of Oslo, Oslo, Norway
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luigi P Badano
- Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHS Trust and University of Bristol and Bristol NIRH Cardiovascular Biomedical Research Unit, Bristol, UK
| | - Nuno Cardim
- Department of Cardiology, Multimodality Cardiac Imaging Center, Sports Cardiology and Cardiomyopathies Center, Hospital da Luz, Lisbon, Portugal
| | - Oliver Gaemperli
- Interventional Cardiology and Cardiac Imaging, University Heart Center Zurich, Zurich, Switzerland
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Gilbert Habib
- Aix-Marseille Université, Marseille and Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu, Turku, Finland
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium and Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - William McKenna
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar and Imperial College, London, UK
| | - Danilo Neglia
- Cardiovascular Department at Fondazione Toscana G. Monasterio, CNR Institute of Clinical Physiology and Scuola Superiore San’Anna, Pisa, Italy
| | - Bogdan A Popescu
- University of Medicine and Pharmacy “Carol Davila”—Euroecolab, Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu,” Bucharest, Romania
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo and University of Oslo, Oslo, Norway
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10
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Gaido L, Battaglia A, Matta M, Giustetto C, Frea S, Imazio M, Richiardi E, Garberoglio L, Gaita F. Phenotypic expression of ARVC: How 12 lead ECG can predict left or right ventricle involvement. A familiar case series and a review of literature. Int J Cardiol 2017; 236:328-334. [PMID: 28283360 DOI: 10.1016/j.ijcard.2017.02.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/27/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart-muscle disease primarily affecting the right ventricle (RV) and potentially causing sudden death in young people. The natural history of the disease is firstly characterized by a concealed form progressing over a biventricular involvement. Three different cases coming from the same family are presented together with a review of the literature. METHODS AND RESULTS Multi-parameter analysis including imaging and electrocardiographic analysis is presented since the first medical referral with follow-up ranging from 11 to 38years. Case 1 presented a typical RV involvement in agreement with the ECG pattern. Case 2 presented a prevalent left ventricular involvement leading from the beginning to a pattern of dilated cardiomyopathy in agreement with his ECG evolution over the years. On the other side, Case 3 came to observation with a typical RV involvement (similar to Case 1) but with ECG evolution of typical left ventricle involvement (similar to Case 2). The genetic analysis showed a mutation in desmoglein-2 (DSG2) gene: p. Arg49His. Comparison between size and localization of ventricular dyskinesia at cardiovascular imaging and the surface 12 lead electrocardiography are proposed. CONCLUSIONS ARVC may lead to an extreme phenotypic variability in clinical manifestations even within patients coming from the same family in which ARVC is caused by the same genetic mutation. ECG progression over time reflects disease evolution and in particular cases may anticipate wall motion abnormalities by years.
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Affiliation(s)
- Luca Gaido
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Alberto Battaglia
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy.
| | - Mario Matta
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Simone Frea
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Massimo Imazio
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Elena Richiardi
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Lucia Garberoglio
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, University of Turin, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, Turin, Italy
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Karlsson D, Engvall J, Ando AA, Aneq MÅ. Exercise testing for long-term follow-up in arrhythmogenic right ventricular cardiomyopathy. J Electrocardiol 2016; 50:176-183. [PMID: 28012557 DOI: 10.1016/j.jelectrocard.2016.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We investigated arrhythmia, electrocardiography and physical work capacity (PWC) in the follow-up of ARVC. DESIGN Twenty-three patients (13 men; age 41±12years) fulfilling diagnostic criteria were re-investigated after at least five years. RESULTS Ventricular arrhythmia during exercise testing (ET) was present in 14 patients (61%) and showed variation between examinations. In eleven (48%), complex ventricular ectopic activity was observed at peak exercise or immediately thereafter. Mutations known to be pathogenic in ARVC were present in 13 patients (57%) of which 11 developed complex ventricular arrhythmia at ET. PWC at baseline was 190±66W (104±26%) decreasing to 151±61W (91±23%, p=0.008) after 10.7years. CONCLUSION The appearance of ventricular arrhythmia during exercise testing showed temporal variation but was frequent in patients with relevant genetic mutation. Physical exercise capacity decreased over time in patients with ARVC in excess to the age-related deterioration and regardless of medication.
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Affiliation(s)
- Daniel Karlsson
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Agota Alfoldine Ando
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Akdis D, Brunckhorst C, Duru F, Saguner AM. Arrhythmogenic Cardiomyopathy: Electrical and Structural Phenotypes. Arrhythm Electrophysiol Rev 2016; 5:90-101. [PMID: 27617087 PMCID: PMC5013177 DOI: 10.15420/aer.2016.4.3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes. At later stages, heart failure may occur. Diagnosis is established with the 2010 Task Force Criteria (TFC). Modern imaging tools are crucial for ACM diagnosis, including both echocardiography and cardiac magnetic resonance imaging for detecting functional and structural alternations. Of note, structural findings often become visible after electrical alterations, such as premature ventricular beats, ventricular fibrillation (VF) and ventricular tachycardia (VT). 12-lead ECG is important to assess for depolarisation and repolarisation abnormalities, including T-wave inversions as the most common ECG abnormality. Family history and the detection of causative mutations, mostly affecting the desmosome, have been incorporated in the TFC, and stress the importance of cascade family screening. Differential diagnoses include idiopathic right ventricular outflow tract (RVOT) VT, sarcoidosis, congenital heart disease, myocarditis, dilated cardiomyopathy, athlete's heart, Brugada syndrome and RV infarction. Therapeutic strategies include restriction from endurance and competitive sports, β-blockers, antiarrhythmic drugs, heart failure medication, implantable cardioverter-defibrillators and endocardial/epicardial catheter ablation.
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Affiliation(s)
- Deniz Akdis
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
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13
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Berte B, Denis A, Amraoui S, Yamashita S, Komatsu Y, Pillois X, Sacher F, Mahida S, Wielandts JY, Sellal JM, Frontera A, Al Jefairi N, Derval N, Montaudon M, Laurent F, Hocini M, Haïssaguerre M, Jaïs P, Cochet H. Characterization of the Left-Sided Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Arrhythm Electrophysiol 2015; 8:1403-12. [DOI: 10.1161/circep.115.003213] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/06/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Benjamin Berte
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Arnaud Denis
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Sana Amraoui
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Seigo Yamashita
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Yuki Komatsu
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Xavier Pillois
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Frédéric Sacher
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Saagar Mahida
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Jean-Yves Wielandts
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Jean-Marc Sellal
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Antonio Frontera
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Nora Al Jefairi
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Nicolas Derval
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Michel Montaudon
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - François Laurent
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Mélèze Hocini
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Michel Haïssaguerre
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Pierre Jaïs
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
| | - Hubert Cochet
- From the Hôpital Cardiologique du Haut-Lévêque (CHU), Bordeaux-Pessac, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., S.M., J.-Y.W., J.-M.S., A.F., N.A.J., N.D., M.M., F.L., M.H., M.H., P.J., H.C.); and L’Institut de RYthmologie et Modélisation Cardiaque (LIRYC), Institut Hospitalo-Universitaire (IHU), Bordeaux, France (B.B., A.D., S.A., S.Y., Y.K., X.P., F.S., J.-Y.W., J.-M.S., A.F., N.D., M.M., M.H., M.H., P.J., H.C.)
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14
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Mast TP, Teske AJ, vd Heijden JF, Groeneweg JA, Te Riele AS, Velthuis BK, Hauer RN, Doevendans PA, Cramer MJ. Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Assessed by Echocardiography Predicts Adverse Clinical Outcome. J Am Soc Echocardiogr 2015; 28:1103-13.e9. [DOI: 10.1016/j.echo.2015.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Indexed: 11/29/2022]
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15
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El Ghannudi S, Nghiem A, Germain P, Jeung MY, Gangi A, Roy C. Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy - a cardiac magnetic resonance imaging study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:27-36. [PMID: 25788837 PMCID: PMC4357611 DOI: 10.4137/cmc.s18770] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/01/2014] [Accepted: 12/06/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Few studies evaluated left ventricular (LV) involvement in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). The aim of this study is to determine the frequency, clinical presentation, and pattern of LV involvement in ARVD/C (LV-ARVD/C). METHODS We retrospectively evaluated the cardiac magnetic resonance (CMR) in 202 patients referred between 2008 and 2012 to our institution, and we determined the presence or the absence of CMR criteria in the revised task force criteria 2010 for the diagnosis of ARVD/C. A total of 21 patients were diagnosed with ARVD/C according to the revised task force criteria 2010. All included patients had no previous history of myocarditis, acute coronary syndrome, or any other cardiac disease that could interfere with the interpretations of structural abnormalities. The LV involvement in ARVD/C was defined by the presence of one or more of the following criteria: LV end-diastolic volume (LVEDV; >95 mL/m2), LV ejection fraction (LVEF; <55%), LV late enhancement of gadolinium (LVLE) in a non-ischemic pattern, and LV wall motion abnormalities (WMAs). In the follow-up for the occurrence of cardiac death, ventricular tachycardia (VT) was obtained at a mean of 31 ± 20.6 months. RESULTS A total of 21 patients had ARVD/C. The median age was 48 (33–63) years. In all, 11 patients (52.4%) had LV-ARVD/C. The demographic characteristics of patients with or without LV were similar. There was a higher frequency of left bundle-branch block (LBBB) VT morphology in ARVD/C (P = 0.04). In CMR, regional WMAs of right ventricle (RV) and RV ejection fraction (RVEF; <45%) were strongly correlated with LV-WMAs (r = 0.72, P = 0.02, r = 0.75, P = 0.02, respectively). RV late enhancement of gadolinium (RVLE) was associated with LV-WMs and LVLE (r = 0.7, P = 0.03; r = 0.8, P = 0.006). LVLE was associated with LV-WMAs, LVEF, and LVEDV (r = 0.9, P = 0.001; r = 0.8, P = 0.001; r = 0.8, P = 0.01). CONCLUSION LV involvement in ARVD/C is common and frequently associated with moderate to severe right ventricular (RV) abnormalities. The impact of LV involvement in ARVD/C on the prognosis needs further investigations.
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Affiliation(s)
- Soraya El Ghannudi
- Radiology Department, University Hospital of Strasbourg, Strasbourg, France. ; Nuclear Medicine Department, University Hospital of Strasbourg, Strasbourg, France
| | - Anthony Nghiem
- Cardiology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Philippe Germain
- Radiology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Mi-Young Jeung
- Radiology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Radiology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Roy
- Radiology Department, University Hospital of Strasbourg, Strasbourg, France
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te Riele ASJM, Tandri H, Bluemke DA. Arrhythmogenic right ventricular cardiomyopathy (ARVC): cardiovascular magnetic resonance update. J Cardiovasc Magn Reson 2014; 16:50. [PMID: 25191878 PMCID: PMC4222825 DOI: 10.1186/s12968-014-0050-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 06/24/2014] [Indexed: 12/23/2022] Open
Abstract
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is one of the most arrhythmogenic forms of inherited cardiomyopathy and a frequent cause of sudden death in the young. Affected individuals typically present between the second and fourth decade of life with arrhythmias coming from the right ventricle. Pathogenic mutations in genes encoding the cardiac desmosome can be found in approximately 60% of index patients, leading to our current perception of ARVC as a desmosomal disease. Although ARVC is known to preferentially affect the right ventricle, early and/or predominant left ventricular involvement is increasingly recognized. Diagnosis is made by combining multiple sources of diagnostic information as prescribed by the "Task Force" criteria. Recent research suggests that electrical abnormalities precede structural changes in ARVC. Cardiovascular Magnetic Resonance (CMR) is an ideal technique in ARVC workup, as it provides comprehensive information on cardiac morphology, function, and tissue characterization in a single investigation. Prevention of sudden cardiac death using implantable cardioverter-defibrillators is the most important management consideration. This purpose of this paper is to provide an updated review of our understanding of the genetics, diagnosis, current state-of-the-art CMR acquisition and analysis, and management of patients with ARVC.
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Affiliation(s)
- Anneline SJM te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda 20892, MD, USA
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Saguner AM, Brunckhorst C, Duru F. Arrhythmogenic ventricular cardiomyopathy: A paradigm shift from right to biventricular disease. World J Cardiol 2014; 6:154-174. [PMID: 24772256 PMCID: PMC3999336 DOI: 10.4330/wjc.v6.i4.154] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/29/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic ventricular cardiomyopathy (AVC) is generally referred to as arrhythmogenic right ventricular (RV) cardiomyopathy/dysplasia and constitutes an inherited cardiomyopathy. Affected patients may succumb to sudden cardiac death (SCD), ventricular tachyarrhythmias (VTA) and heart failure. Genetic studies have identified causative mutations in genes encoding proteins of the intercalated disk that lead to reduced myocardial electro-mechanical stability. The term arrhythmogenic RV cardiomyopathy is somewhat misleading as biventricular involvement or isolated left ventricular (LV) involvement may be present and thus a broader term such as AVC should be preferred. The diagnosis is established on a point score basis according to the revised 2010 task force criteria utilizing imaging modalities, demonstrating fibrous replacement through biopsy, electrocardiographic abnormalities, ventricular arrhythmias and a positive family history including identification of genetic mutations. Although several risk factors for SCD such as previous cardiac arrest, syncope, documented VTA, severe RV/LV dysfunction and young age at manifestation have been identified, risk stratification still needs improvement, especially in asymptomatic family members. Particularly, the role of genetic testing and environmental factors has to be further elucidated. Therapeutic interventions include restriction from physical exercise, beta-blockers, sotalol, amiodarone, implantable cardioverter-defibrillators and catheter ablation. Life-long follow-up is warranted in symptomatic patients, but also asymptomatic carriers of pathogenic mutations.
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Saguner AM, Vecchiati A, Baldinger SH, Rüeger S, Medeiros-Domingo A, Mueller-Burri AS, Haegeli LM, Biaggi P, Manka R, Lüscher TF, Fontaine G, Delacrétaz E, Jenni R, Held L, Brunckhorst C, Duru F, Tanner FC. Different prognostic value of functional right ventricular parameters in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circ Cardiovasc Imaging 2014; 7:230-9. [PMID: 24515411 DOI: 10.1161/circimaging.113.000210] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The value of standard 2-dimensional transthoracic echocardiographic parameters for risk stratification in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is controversial. METHODS AND RESULTS We investigated the impact of RV fractional area change (FAC) and tricuspid annulus plane systolic excursion (TAPSE) for the prediction of major adverse cardiovascular events (MACE) defined as the occurrence of cardiac death, heart transplantation, survived sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or arrhythmogenic syncope. Among 70 patients who fulfilled the 2010 ARVC/D Revised Task Force Criteria and underwent baseline transthoracic echocardiography, 37 (53%) patients experienced MACE during a median follow-up period of 5.3 (interquartile range, 1.8-9.8) years. Average values for FAC, TAPSE, and TAPSE indexed to body surface area (BSA) decreased over time (P=0.03 for FAC, P=0.03 for TAPSE, and P=0.01 for TAPSE/BSA, each versus baseline). In contrast, median RV end-diastolic area increased (P=0.001 versus baseline). Based on the results of Kaplan-Meier estimates, the time between baseline transthoracic echocardiography and experiencing MACE was significantly shorter for patients with FAC <23% (P<0.001), TAPSE <17 mm (P=0.02), or right atrial short axis/BSA ≥25 mm/m(2) (P=0.04) at baseline. A reduced FAC constituted the strongest predictor of MACE (hazard ratio, 1.08 per 1% decrease; 95% confidence interval, 1.04-1.12; P<0.001) on bivariable analysis. CONCLUSIONS This long-term observational study indicates that TAPSE and dilation of right-sided cardiac chambers are associated with an increased risk for MACE in patients with ARVC/D with advanced disease and a high risk for adverse events. However, FAC is the strongest echocardiographic predictor of adverse outcome in these patients. Our data advocate a role for transthoracic echocardiography in risk stratification in patients with ARVC/D, although our results may not be generalizable to lower-risk ARVC/D cohorts.
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Affiliation(s)
- Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
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Vitarelli A, Cortes Morichetti M, Capotosto L, De Cicco V, Ricci S, Caranci F, Vitarelli M. Utility of strain echocardiography at rest and after stress testing in arrhythmogenic right ventricular dysplasia. Am J Cardiol 2013; 111:1344-50. [PMID: 23411103 DOI: 10.1016/j.amjcard.2013.01.279] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 01/05/2023]
Abstract
The introduction of speckle tracking imaging (STI) allowed the quantification of the regional myocardial function in the right ventricular (RV) free wall using deformation parameters. We sought to evaluate the potential utility of STI at rest and after stress to predict arrhythmogenic RV dysplasia (ARVD). We studied 19 patients with ARVD (diagnosed according to the task force criteria) and 19 healthy age- and gender-matched subjects. Both 2-dimensional and 3-dimensional echocardiography were performed. The RV and left ventricular annular peak systolic velocities were measured using tissue Doppler imaging. The RV-left ventricular peak systolic longitudinal strain (LS) was obtained in the basal, mid, and apical segments in the apical 4-chamber view using STI. An exercise stress-echocardiographic test was undertaken using bicycle ergometry with the patient in the supine position for all patients, and the indexes were assessed at peak effort. The STI measurements were determined using offline analysis programs. The 3-dimensional RV ejection fraction and strain were significantly lower in patients with ARVD than in the controls. The RV strain values at rest did not change significantly during maximum physical effort in the patients with ARVD. The receiver operating characteristic curves suggested that the thresholds offering an adequate compromise between sensitivity and specificity for the detection of ARVD were 9.35 cm/s for the RV annular peak systolic velocity (area under the curve 0.81), 42% for 3-dimensional RV ejection fraction (area under the curve 0.85), -25% for mean global RV-LS (area under the curve 0.86), -18% for the lowest peak systolic RV-LS (area under the curve 0.88), and -1.2 for peak minus baseline global change of stress RV-LS (area under the curve 0.92). In conclusion, STI at rest and during stress might enable quantitative assessment of RV function and the detection of ARVD and have potential clinical value in the treatment of these patients.
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Aneq MÅ, Engvall J, Brudin L, Nylander E. Evaluation of right and left ventricular function using speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy and their first degree relatives. Cardiovasc Ultrasound 2012; 10:37. [PMID: 22992412 PMCID: PMC3503613 DOI: 10.1186/1476-7120-10-37] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/11/2012] [Indexed: 12/21/2022] Open
Abstract
Introduction and aim The identification of right ventricular abnormalities in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is still difficult. The aim of this study was to investigate if longitudinal strain based on speckle tracking can detect subtle right (RV) or left ventricular (LV) dysfunction as an early sign of ARVC. Methods and results Seventeen male patients, fulfilling Task force criteria for ARVC, 49 (32–70) years old, nineteen male first degree relatives 29 (19–73) y.o. and twenty-two healthy male volunteers 36 (24–66) y.o participated in the study. Twelve-lead and signal-averaged electrocardiograms were recorded. All subjects underwent echocardiography. LV and RV diameters, peak systolic velocity from tissue Doppler and longitudinal strain based on speckle tracking were measured from the basal and mid segments in both ventricles. RV longitudinal strain measurement was successful in first degree relatives and controls (95 resp. 86%) but less feasible in patients (59%). Results were not systematically different between first degree relatives and controls. Using discriminant analysis, we then developed an index based on echocardiographic parameters. All normal controls had an index < l while patients with abnormal ventricles had an index between 1–4. Some of the first degree relatives deviated from the normal pattern. Conclusion Longitudinal strain of LV and RV segments was significantly lower in patients than in relatives and controls. An index was developed incorporating dimensional and functional echocardiographic parameters. In combination with genetic testing this index might help to detect early phenotype expression in mutation carriers.
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Affiliation(s)
- Meriam Åström Aneq
- Division of Clinical Physiology, Department of Medical and Health Sciences, Faculty of Health Sciences, Department of Clinical Physiology, County Council of Östergötland, Linköping University, Linköping, Sweden.
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Pieperhoff S. Gene Mutations Resulting in the Development of ARVC/D Could Affect Cells of the Cardiac Conduction System. Front Physiol 2012; 3:22. [PMID: 22363295 PMCID: PMC3281278 DOI: 10.3389/fphys.2012.00022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/30/2012] [Indexed: 11/26/2022] Open
Abstract
In contrast to epithelial cells, cardiomyocytes are connected by complex hybrid-type adhering junctions, termed composite junctions (areae compositae). Composite junctions are found to be composed of typical desmosomal as well as adherens junction proteins. Therefore, in adult mammalian cardiomyocytes desmosomal proteins are not restricted to the relatively small desmosomes but are indirectly involved in anchoring the myofibrillar actin filaments. Subsequent investigations revealed that the formation of composite junctions is a rather late event during mammalian heart development and vertebrate heart evolution. Nascent, more round shaped cardiomyocytes of early developmental stages are connected by desmosomes and separate adherens junctions quite similar to cells of epithelial origin. During progression of development both types of adhering junctions seem to gradually fuse at the two poles of the mature mammalian cardiomyocytes to establish the hybrid-type composite junctions. Recently, we demonstrated that the specialized cardiomyocytes of the cardiac conduction system exhibit high amounts of desmosomes, not fully established composite junctions and adherens junctions. This underlines the fact that cells of the cardiac conduction system are known to resemble cardiomyocytes in their nascent state and do not undergo working myocardial differentiation. However, the astonishing high amount of desmosomal protein containing adhering junctions connecting, e.g., Purkinje fibers raises the possibility that pacemaker and conductive tissue may be affected by desmosomal gene mutations in ARVC/D patients.
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Affiliation(s)
- Sebastian Pieperhoff
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh Scotland, UK
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A novel variant in plakophilin-2 gene detected in a family with arrhythmogenic right ventricular cardiomyopathy. J Interv Card Electrophysiol 2011; 34:11-8. [PMID: 22170284 DOI: 10.1007/s10840-011-9643-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/09/2011] [Indexed: 10/14/2022]
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by fibrofatty replacement of muscular fibers predominantly in the right ventricle and with ventricular arrhythmias as the main clinical manifestation. Mutations in several components of the desmosome genes have been identified and mutations of the plakophilin-2 (PKP-2) gene are a common cause of ARVC. The aim of this study is to investigate the correlation between genotype and phenotype in a family with a novel PKP-2 variant. METHODS AND RESULTS This study describes the clinical findings and genetic analysis in a family with ARVC. A part of the family has been followed clinically long term for up to 27 years. Two not previously reported PKP-2 variants (L506P and T526A) have been identified in this family. Even though all members of this family share the novel variant L506P, the clinical features, i.e., their phenotypes are different. The L506P variant is located in exon 7 and affects a highly conserved residue. The same amino acid, leucine, is present in all species evaluated, indicating a functional importance and the variant is predicted to be damaging. The novel L506P variant in the PKP-2 gene is thus a possible pathogenic alteration in the described family with ARVC. In contrast, the T526A variant is weakly conserved and predicted to be tolerated. CONCLUSION While many of the reported ARVC mutations are truncating mutations, the possibly damaging variant found in this family, is a missense alteration affecting a highly conserved residue 506 located in exon 7.
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Marra MP, Leoni L, Bauce B, Corbetti F, Zorzi A, Migliore F, Silvano M, Rigato I, Tona F, Tarantini G, Cacciavillani L, Basso C, Buja G, Thiene G, Iliceto S, Corrado D. Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy: comparison of 3D standard electroanatomical voltage mapping and contrast-enhanced cardiac magnetic resonance. Circ Arrhythm Electrophysiol 2011; 5:91-100. [PMID: 22139887 DOI: 10.1161/circep.111.964635] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The hallmark lesion of arrhythmogenic right ventricular cardiomyopathy (ARVC) is fibrofatty scar replacement. We compared endocardial voltage mapping (EVM) and contrast-enhanced cardiac magnetic resonance (CE-CMR) for imaging scar lesions in ARVC patients. METHODS AND RESULTS We studied 23 consecutive ARVC patients (16 males; mean age, 38±12 years) who underwent RV EVM and CE-CMR and 37 control subjects. In 21 (91%) of 23 ARVC patients, RV EVM was abnormal, with a total of 45 electroanatomical scars (EAS): 17 (38%) in the inferobasal region, 12 (26.6%) in the anterolateral region, 8 (17.7%) in the RV outflow tract (RVOT), and 8 (17.7%) in the apex. RV delayed contrast enhancement (DCE) was found in 9 (39%) of 23 patients, with a total of 23 RV DCE scars: 4 (17.4%) in the inferobasal region, 9 (39.1%) in the anterolateral region, 4 (17.4%) in the RVOT, and 6 (26.1%) in the apex. There was a mismatch in 24 RV scars, with 22 EAS not confirmed by DCE and 2 DCE scars (both in the RVOT) undetected by EVM. In 9 (75%) of 12 patients with abnormal RV EVM/normal RV DCE, ≥1 DCEs were identified in the left ventricle (LV). Overall, ventricular DCE was detected in 78% of patients. No control subjects showed either EAS or DCE. CONCLUSIONS EVM and CE-CMR allow identification of RV scar lesions in most ARVC patients. CE-CMR is less sensitive than EVM in identifying RV scar lesions. The high prevalence of LV DCE confirms the frequent biventricular involvement and indicates the diagnostic relevance of LV scar detection by CE-CMR.
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Affiliation(s)
- Martina Perazzolo Marra
- Departments of Cardiac, Thoracic, and Vascular Sciences, Radiology, and Medical-Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy
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Tavora F, Zhang M, Franco M, Oliveira JB, Li L, Fowler D, Zhao Z, Cresswell N, Burke A. Distribution of biventricular disease in arrhythmogenic cardiomyopathy: an autopsy study. Hum Pathol 2011; 43:592-6. [PMID: 21937076 DOI: 10.1016/j.humpath.2011.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/08/2011] [Accepted: 06/10/2011] [Indexed: 12/22/2022]
Abstract
Arrhythmogenic cardiomyopathy is a rare cardiomyopathy characterized by fibrofatty replacement primarily of the right ventricular myocardium. It is a major cause of sudden death in the young and in athletes. There are few autopsy studies of the ventricular distribution of the disease. Fifty cases of sudden cardiac death with fibrofatty replacement in either ventricle from a single medical examiner's office were studied. Distribution of disease as determined grossly and microscopically was correlated with activity at time of death, race, and presence of inflammation. Extent of disease was right ventricular in 6 cases (12%; age, 25 ± 5 years), biventricular in 25 (50%; age, 36 ± 3 years), and left ventricular in 19 (38%; age, 37 ± 3 years) (P = .13). Inflammation was present in 44% of biventricular arrhythmogenic cardiomyopathy versus 74% of left ventricular arrhythmogenic cardiomyopathy and 83% of right ventricular arrhythmogenic cardiomyopathy (P = .06). Arrhythmogenic cardiomyopathy, when presenting with sudden death, is usually biventricular. There is a trend that univentricular involvement occurs at an earlier age and that right ventricular involvement shows more inflammation, suggesting different stages of disease.
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Affiliation(s)
- Fabio Tavora
- Department of Pathology, Escola Paulista de Medicina, UNIFESP, Sao Paulo 04023-900, Brazil
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Pinamonti B, Dragos AM, Pyxaras SA, Merlo M, Pivetta A, Barbati G, Di Lenarda A, Morgera T, Mestroni L, Sinagra G. Prognostic predictors in arrhythmogenic right ventricular cardiomyopathy: results from a 10-year registry. Eur Heart J 2011; 32:1105-13. [PMID: 21362707 DOI: 10.1093/eurheartj/ehr040] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS We sought to examine the clinical presentation and natural history and to identify long-term prognostic predictors in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) as information concerning the natural history and risk stratification of ARVC is still incomplete. METHODS AND RESULTS A cohort of 96 ARVC patients (68% males, 35 ± 15 years) was enrolled and underwent structured diagnostic protocol and follow-up. Primary study endpoints were death and heart transplantation (HTx). Clinical and echo-Doppler data were assessed as prognostic indicators. Sixty-five per cent of patients had right ventricular (RV) systolic dysfunction (RV fractional area change < 33%) and 24% had left ventricular (LV) systolic dysfunction (LV ejection fraction <50%). During a mean follow-up of 128 ± 92 months, 20 patients (21%) experienced cardiac death or underwent HTx. At multivariate analysis (Model 1), RV dysfunction [hazard ratio (HR): 4.12; 95% confidence interval (CI): 1.01-18.0; P = 0.05], significant tricuspid regurgitation (HR: 7.6; 95% CI: 2.6-22.0; P < 0.001), and amiodarone treatment (HR: 3.4; 95% CI: 1.3-8.8; P = 0.01) resulted as predictors of death/HTx. When inserting in the model, the 'ordinal dysfunction' (Model 2), which considers the presence of both RV and LV dysfunctions, this variable emerged as an independent prognostic predictor (HR: 6.3; 95% CI: 2.17-17.45; P < 0.001). At the receiver operating characteristic analysis, Model 2 was significantly more accurate in predicting long-term outcome compared with Model 1 (area under the curve 0.84 vs. 0.78, respectively; P = 0.04). CONCLUSION In our tertiary referral centre ARVC population, the presence of LV dysfunction at diagnosis has an incremental power in predicting adverse outcome compared with RV dysfunction alone.
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Affiliation(s)
- Bruno Pinamonti
- Cardiovascular Department, Azienda Ospedaliera Ospedali Riuniti and University of Trieste, Trieste, Italy.
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Jain A, Shehata ML, Stuber M, Berkowitz SJ, Calkins H, Lima JAC, Bluemke DA, Tandri H. Prevalence of left ventricular regional dysfunction in arrhythmogenic right ventricular dysplasia: a tagged MRI study. Circ Cardiovasc Imaging 2010; 3:290-7. [PMID: 20197508 DOI: 10.1161/circimaging.109.911313] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although arrhythmogenic right ventricular dysplasia (ARVD) predominantly affects the right ventricle (RV), genetic/molecular and histological changes are biventricular. Regional left ventricular (LV) function has not been systematically studied in ARVD. METHODS AND RESULTS The study population included 21 patients with suspected ARVD who underwent evaluation with MRI including tagging. Eleven healthy volunteers served as control subjects. Peak systolic regional circumferential strain (Ecc, %) was calculated by harmonic phase from tagged MRI based on the 16-segment model. Patients who met ARVD Task Force criteria were classified as definite ARVD, whereas patients with a positive family history who had 1 additional minor criterion and patients without a family history with 1 major or 2 minor criteria were classified as probable ARVD. Of the 21 ARVD subjects, 11 had definite ARVD and 10 had probable ARVD. Compared with control subjects, probable ARVD patients had similar RV ejection fraction (58.9+/-6.2% versus 53.5+/-7.6%, P=0.20), but definite ARVD patients had significantly reduced RV ejection fraction (58.9+/-6.2% versus 45.2+/-6.0%, P=0.001). LV ejection fraction was similar in all 3 groups. Compared with control subjects, peak systolic Ecc was significantly less negative in 6 of 16 (37.5%) segments in definite ARVD and 3 of 16 segments (18.7%) in probable ARVD (all P<0.05). CONCLUSIONS ARVD is associated with regional LV dysfunction, which appears to parallel degree of RV dysfunction. Further large studies are needed to validate this finding and to better define implications of subclinical segmental LV dysfunction.
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Affiliation(s)
- Aditya Jain
- Department of Radiology, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Aneq MA, Lindström L, Fluur C, Nylander E. Long-term follow-up in arrhythmogenic right ventricular cardiomyopathy using tissue Doppler imaging. SCAND CARDIOVASC J 2009; 42:368-74. [PMID: 18781452 DOI: 10.1080/14017430802372384] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To study patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and describe different echocardiographic parameters and their change over time during almost 10 years follow-up period. METHODS Fifteen patients (9 male, 6 female), aged 22-58 years (mean 40) with a diagnosis of ARVC, were followed up for a period of 6-10 years (mean 8.7). Twelve-lead and a signal- averaged ECG was recorded. Tricuspid and mitral annular motion and tissue Doppler imaging were registered by echocardiography. Wall motion score index (WMSI) was calculated for the left and right ventricles. RESULTS We registered significant reduction in systolic tissue velocity on right ventricle free wall between the first and last investigations: 7-17 cm/s (mean 11.8) to 4-15 (mean 9.1), p=0.005. WMSI increased by at least 0.2 in 10/14 patients for the right and in 8/15 patients for the left ventricle. A decrease in velocity time integral for the left ventricular outflow was observed (16-30 to 13-21, p=0.009). CONCLUSION ARVC is a progressive disease with individual variation. Left ventricular involvement may occur early in the disease. Tissue Doppler imaging is a useful tool to follow-up right ventricular abnormalities.
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Affiliation(s)
- Meriam Aström Aneq
- Department of Clinical Physiology, University Hospital, Linkoping, Sweden.
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Jain A, Tandri H, Calkins H, Bluemke DA. Role of cardiovascular magnetic resonance imaging in arrhythmogenic right ventricular dysplasia. J Cardiovasc Magn Reson 2008; 10:32. [PMID: 18570661 PMCID: PMC2483704 DOI: 10.1186/1532-429x-10-32] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 06/20/2008] [Indexed: 12/25/2022] Open
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is a genetic cardiomyopathy characterized clinically by ventricular arrhythmias and progressive right ventricular (RV) dysfunction. The histopathologic hallmark is fibro-fatty replacement of RV myocardium. It is inherited in an autosomal pattern with variable penetrance. ARVD is unique in that it most commonly presents in young, otherwise healthy and highly athletic individuals. The cause of ARVD is not well-known but recent evidence suggests strongly that it is a disease of desmosomal dysfunction. The disease involvement is not limited only to the RV as left ventricle (LV) has also been reportedly affected. Diagnosis of ARVD is challenging and is currently based upon a multi-disciplinary work-up of the patient as defined by the Task Force. Currently, implanted cardioverter defibrillators (ICD) are routinely used to prevent sudden death in patients with ARVD. Cardiovascular MR is an important non-invasive diagnostic modality that allows both qualitative and quantitative evaluation of RV. This article reviews the genetics of ARVD, current status and role of CMR in the diagnosis of ARVD and LV involvement in ARVD.
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Affiliation(s)
- Aditya Jain
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Merner ND, Hodgkinson KA, Haywood AF, Connors S, French VM, Drenckhahn JD, Kupprion C, Ramadanova K, Thierfelder L, McKenna W, Gallagher B, Morris-Larkin L, Bassett AS, Parfrey PS, Young TL. Arrhythmogenic right ventricular cardiomyopathy type 5 is a fully penetrant, lethal arrhythmic disorder caused by a missense mutation in the TMEM43 gene. Am J Hum Genet 2008; 82:809-21. [PMID: 18313022 PMCID: PMC2427209 DOI: 10.1016/j.ajhg.2008.01.010] [Citation(s) in RCA: 338] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 12/11/2007] [Accepted: 01/08/2008] [Indexed: 12/14/2022] Open
Abstract
Autosomal-dominant arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) causes sudden cardiac death and is characterized by clinical and genetic heterogeneity. Fifteen unrelated ARVC families with a disease-associated haplotype on chromosome 3p (ARVD5) were ascertained from a genetically isolated population. Identification of key recombination events reduced the disease region to a 2.36 Mb interval containing 20 annotated genes. Bidirectional resequencing showed one rare variant in transmembrane protein 43 (TMEM43 1073C-->T, S358L), was carried on all recombinant ARVD5 ancestral haplotypes from affected subjects and not found in population controls. The mutation occurs in a highly conserved transmembrane domain of TMEM43 and is predicted to be deleterious. Clinical outcomes in 257 affected and 151 unaffected subjects were compared, and penetrance was determined. We concluded that ARVC at locus ARVD5 is a lethal, fully penetrant, sex-influenced morbid disorder. Median life expectancy was 41 years in affected males compared to 71 years in affected females (relative risk 6.8, 95% CI 1.3-10.9). Heart failure was a late manifestation in survivors. Although little is known about the function of the TMEM43 gene, it contains a response element for PPAR gamma (an adipogenic transcription factor), which may explain the fibrofatty replacement of the myocardium, a characteristic pathological finding in ARVC.
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Affiliation(s)
- Nancy D. Merner
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador A1B 3V6, Canada
| | - Kathy A. Hodgkinson
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador A1B 3V6, Canada
| | - Annika F.M. Haywood
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador A1B 3V6, Canada
| | - Sean Connors
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador A1B 3V6, Canada
| | - Vanessa M. French
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador A1B 3V6, Canada
| | - Jörg-Detlef Drenckhahn
- Max-Delbrück Centrum für Molekulare Medizin, Max-Delbruck-Zentrum, Kostenstelle 1109, Robert-Roessle-Str 10, Berlin 13122, Germany
| | - Christine Kupprion
- Max-Delbrück Centrum für Molekulare Medizin, Max-Delbruck-Zentrum, Kostenstelle 1109, Robert-Roessle-Str 10, Berlin 13122, Germany
| | - Kalina Ramadanova
- Max-Delbrück Centrum für Molekulare Medizin, Max-Delbruck-Zentrum, Kostenstelle 1109, Robert-Roessle-Str 10, Berlin 13122, Germany
| | - Ludwig Thierfelder
- Max-Delbrück Centrum für Molekulare Medizin, Max-Delbruck-Zentrum, Kostenstelle 1109, Robert-Roessle-Str 10, Berlin 13122, Germany
| | - William McKenna
- The Heart Hospital, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - Barry Gallagher
- Department of Pathology, James Paton Memorial Regional Health Centre, Gander, Newfoundland and Labrador A1V 1P7, Canada
| | - Lynn Morris-Larkin
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador A1B 3V6, Canada
| | - Anne S. Bassett
- Centre for Addiction and Mental Health, Clinical Genetics Research Program, University of Toronto, 1001 Queen Street West, Unit 4, Toronto, Ontario M6J 1H4, Canada
| | - Patrick S. Parfrey
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador A1B 3V6, Canada
| | - Terry-Lynn Young
- Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador A1B 3V6, Canada
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Sen-Chowdhry S, Syrris P, McKenna WJ. Role of genetic analysis in the management of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol 2007; 50:1813-21. [PMID: 17980246 DOI: 10.1016/j.jacc.2007.08.008] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 07/02/2007] [Accepted: 08/06/2007] [Indexed: 12/23/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a recognized cause of sudden cardiac death, which may be prevented by timely detection and intervention. Clinical diagnosis of ARVC is fraught with difficulties in both index cases and relatives owing to the nonspecific nature of associated features, diverse phenotypic manifestations, and a lack of conspicuous abnormalities in the early, "concealed" phase. During the past 7 years, researchers have isolated causative mutations in several components of the desmosome, shedding light on the molecular mechanisms underlying the disease and offering the promise of genetic testing as a diagnostic tool. Sequence analysis is likely to be the mainstay of genotyping in ARVC because of marked allelic heterogeneity, frequent "private" mutations, and digenicity in a minority, highlighting the importance of comprehensive genetic screening. The main technical obstacle to implementation of genotyping in clinical practice will be the prohibitive costs of performing sequence analysis of a genomic region exceeding 40 kb. Nevertheless, the success rate of genotyping in ARVC is of the order of 40%, and key clinical applications include confirmatory testing of index cases to facilitate interpretation of borderline investigations and cascade screening of families. The latter is particularly attractive in ARVC, because age-related penetrance otherwise demands lifelong clinical reassessment of extended families. A role for genetic analysis in prognostication is more tenuous at present, but increasing identification of individuals with early and familial disease underscores the need for a definitive risk stratification algorithm in this population.
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Affiliation(s)
- Srijita Sen-Chowdhry
- Cardiology in the Young, The Heart Hospital, University College London, London, United Kingdom
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Sen-Chowdhry S, Syrris P, Ward D, Asimaki A, Sevdalis E, McKenna WJ. Clinical and genetic characterization of families with arrhythmogenic right ventricular dysplasia/cardiomyopathy provides novel insights into patterns of disease expression. Circulation 2007; 115:1710-20. [PMID: 17372169 DOI: 10.1161/circulationaha.106.660241] [Citation(s) in RCA: 369] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND According to clinical-pathological correlation studies, the natural history of arrhythmogenic right ventricular dysplasia/cardiomyopathy is purported to progress from localized to global right ventricular dysfunction, followed by left ventricular (LV) involvement and biventricular pump failure. The inevitable focus on sudden death victims and transplant recipients may, however, have created a skewed perspective of a genetic disease. We hypothesized that unbiased representation of the spectrum of disease expression in arrhythmogenic right ventricular dysplasia/cardiomyopathy would require in vivo assessment of families in a genetically heterogeneous population. METHODS AND RESULTS A cohort of 200 probands and relatives satisfying task force or modified diagnostic criteria for arrhythmogenic right ventricular dysplasia/cardiomyopathy underwent comprehensive clinical evaluation. Desmosomal mutations were identified in 39 individuals from 20 different families. Indices of structural severity correlated with advancing age and were increased in long-term endurance athletes. Fulfillment of modified criteria indicated phenotypically mild disease, whereas asymptomatic status did not. In >80%, ECG, rhythm monitoring, and/or gadolinium-enhanced cardiovascular magnetic resonance were suggestive of LV involvement, the extent of which often was marked among individuals with chain-termination mutations and/or desmoplakin disease. Three patterns of disease expression were identified: (1) classic, with isolated right ventricular disease or LV involvement in association with significant right ventricular impairment; (2) left dominant, with early and prominent LV manifestations and relatively mild right-sided disease; and (3) biventricular, characterized by parallel involvement of both ventricles. CONCLUSIONS LV involvement in arrhythmogenic right ventricular dysplasia/cardiomyopathy may precede the onset of significant right ventricular dysfunction. Recognition of disease variants with early and/or predominant LV involvement supports adoption of the broader term arrhythmogenic cardiomyopathy.
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Kjaergaard J, Hastrup Svendsen J, Sogaard P, Chen X, Bay Nielsen H, Køber L, Kjaer A, Hassager C. Advanced quantitative echocardiography in arrhythmogenic right ventricular cardiomyopathy. J Am Soc Echocardiogr 2007; 20:27-35. [PMID: 17218199 DOI: 10.1016/j.echo.2006.07.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Indexed: 12/22/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) is a regional disease of the RV myocardium with variable degrees of left ventricular involvement. Three-dimensional echocardiography and Doppler tissue imaging (DTI) are new echocardiographic modalities for the evaluation of global and regional function, but the diagnostic potential remains to be assessed. METHODS Twenty patients with previously established ARVC were evaluated by 3-dimensional echocardiography and DTI, and compared with 32 age- and sex-matched control subjects. RESULTS Using 3-dimensional echocardiography, patients with ARVC had a decreased RV ejection fraction (0.47 +/- 0.08 vs 0.53 +/- 0.05, P < .01), and a decreased peak lateral systolic annular velocity by pulsed wave imaging of both the RV (11.9 +/- 2.6 vs 15.1 +/- 3.7 cm/s, P < .01) and the left ventricle (7.0 +/- 2.6 vs 9.5 +/- 1.9 cm/s, P < .01). DTI showed decreased regional systolic strain, but with wide variation in the measurements. CONCLUSION Three-dimensional echocardiography identifies decreased RV ejection fraction in ARVC. Assessment of regional contractility by DTI is limited by wide variation. Echocardiographic evaluation of the longitudinal motility appears to be a sensitive marker of preclinical left ventricular involvement.
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Nishiyama K, Doi T, Shizuta S, Yamamoto T, Hanazawa K, Kita T, Kimura T. A Case Study on Cardiac Imaging in Patients with Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy-A Comparison between 64-Slice Computed Tomography, Magnetic Resonance Imaging and Electroanatomical Mapping-. J Arrhythm 2007. [DOI: 10.4020/jhrs.23.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Nishiyama K, Doi T, Shizuta S, Yamamoto T, Hanazawa K, Kita T, Kimura T. A Case Study on Cardiac Imaging in Patients with Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy —A Comparison between 64-Slice Computed Tomography, Magnetic Resonance Imaging and Electroanatomical Mapping—. J Arrhythm 2007. [DOI: 10.1016/s1880-4276(07)80032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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