1
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Cainap SS, Kovalenko I, Bonamano E, Crousen N, Tirpe A, Cismaru A, Iacob D, Lazea C, Negru A, Cismaru G. Anatomical-MRI Correlations in Adults and Children with Arrhythmogenic Right Ventricular Cardiomyopathy. Diagnostics (Basel) 2021; 11:diagnostics11081388. [PMID: 34441321 PMCID: PMC8392323 DOI: 10.3390/diagnostics11081388] [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: 07/01/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/04/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare disease in which the right ventricular myocardium is replaced by islands of fibro-adipose tissue. Therefore, ventricular re-entry circuits can occur, predisposing the patient to ventricular tachyarrhythmias, as well as dilation of the right ventricle that eventually leads to heart failure. Although it is a rare disease with low prevalence in Europe and the United States, many patients are addressed disproportionately for cardiac magnetic resonance imaging (MRI). The most severe consequence of this condition is sudden cardiac death at a young age due to untreated cardiac arrhythmias. The purpose of this paper is to revise the magnetic resonance characteristics of ARVC, including the segmental contraction abnormalities, fatty tissue replacement, decrease of the ejection fraction, and the global RV dilation. Herein, we also present several recent improvements of the 2010 Task Force criteria that are not included within the ARVC diagnosis guidelines. In our opinion, these features will be considered in a future Task Force Consensus.
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Affiliation(s)
- Simona-Sorana Cainap
- 2nd Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Ilana Kovalenko
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Edoardo Bonamano
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Niclas Crousen
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Alexandru Tirpe
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania;
| | - Daniela Iacob
- 3rd Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Cecilia Lazea
- 1st Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Alina Negru
- Department of Cardiology, ‘Victor Babeș’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-721926230
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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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Rawal AS, VanCleave T, Yedlapati N, Saffitz JE, Craigen WJ, Jefferies JL. Arrhythmogenic Ventricular Cardiomyopathy: Challenges With Complex Genetics and Variable Phenotypes. JACC Case Rep 2021; 3:438-442. [PMID: 34317553 PMCID: PMC8311029 DOI: 10.1016/j.jaccas.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
After a 20-year-old woman suddenly died, autopsy showed characteristic findings of biventricular arrhythmogenic cardiomyopathy. Screening of her family members revealed the same desmoplakin gene mutation and imaging abnormalities predominantly involving the left ventricle. We describe the variable phenotypic expression in a family that shares a common gene variant. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Aranyak S Rawal
- Department of Internal Medicine and Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tara VanCleave
- Department of Cardiology, Sutherland Cardiology Clinic, Memphis, Tennessee, USA
| | - Neeraja Yedlapati
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jeffery E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - William James Craigen
- Department of Genetics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - John L Jefferies
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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4
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Ahmed I, Tipoo FA. Clinical Presentation, Cardiac Magnetic Resonance Findings, and Prognosis of Patients with Arrhythmogenic Right Ventricular Cardiomyopathy - An Experience from Pakistan. J Clin Imaging Sci 2020; 10:48. [PMID: 32874753 PMCID: PMC7451142 DOI: 10.25259/jcis_109_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart-muscle disease, characterized by fibro-fatty replacement and ventricular arrhythmias, that primarily affects the right ventricle (RV). We aimed to look at the clinical presentation, cardiac magnetic resonance (CMR) imaging findings and prognosis of patients with ARVC in Pakistan. Material and Methods: It is a retrospective observational study, 17 consecutive patients with CMR and other findings consistent with ARVC, were enrolled from 2010 to 2019 at a single center. Results: Out of 17 patients, 12 (70.6%) were male with a mean age of 33.5 ± 17.5 years. Family history of sudden cardiac death was present in 3 (17.7%) patients while one (5.9%) patient had family history of ARVC. Syncope was the first presenting symptom in eight (47.1%) patients. On 12 leads ECG, T wave inversion in precordial leads was found in 6 (35.4%) patients, and epsilon wave was present in only 3 (17.7%) patients. On echocardiogram, 13 (76.5%) patients had dilated RV with reduced systolic function. On CMR, majority of patients (n = 14, 82.4%) were found to have RV dilatation with regional dyskinesia and fatty infiltration, 9 (52.9%) of them had left ventricular involvement also. Follow-up was available for 14 patients (82.4%) with a mean follow-up period of 35.5 ± 19.7 months. Three (21.4%) of them died and 10 (71.4%) got admissions for heart failure during follow-up period. Conclusion: Arrhythmia related events are the main presenting symptoms of ARVC in this region, and left ventricular involvement in ARVC is not rare in this population. The mortality is relatively high, probably due to advanced disease at the time of presentation and less medical facilities available.
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Affiliation(s)
- Intisar Ahmed
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Fateh Ali Tipoo
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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5
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Miles C, Finocchiaro G, Papadakis M, Gray B, Westaby J, Ensam B, Basu J, Parry-Williams G, Papatheodorou E, Paterson C, Malhotra A, Robertus JL, Ware JS, Cook SA, Asimaki A, Witney A, Ster IC, Tome M, Sharma S, Behr ER, Sheppard MN. Sudden Death and Left Ventricular Involvement in Arrhythmogenic Cardiomyopathy. Circulation 2020; 139:1786-1797. [PMID: 30700137 PMCID: PMC6467560 DOI: 10.1161/circulationaha.118.037230] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is an inherited heart muscle disorder characterized by myocardial fibrofatty replacement and an increased risk of sudden cardiac death (SCD). Originally described as a right ventricular disease, ACM is increasingly recognized as a biventricular entity. We evaluated pathological, genetic, and clinical associations in a large SCD cohort. METHODS We investigated 5205 consecutive cases of SCD referred to a national cardiac pathology center between 1994 and 2018. Hearts and tissue blocks were examined by expert cardiac pathologists. After comprehensive histological evaluation, 202 cases (4%) were diagnosed with ACM. Of these, 15 (7%) were diagnosed antemortem with dilated cardiomyopathy (n=8) or ACM (n=7). Previous symptoms, medical history, circumstances of death, and participation in competitive sport were recorded. Postmortem genetic testing was undertaken in 24 of 202 (12%). Rare genetic variants were classified according to American College of Medical Genetics and Genomics criteria. RESULTS Of 202 ACM decedents (35.4±13.2 years; 82% male), no previous cardiac symptoms were reported in 157 (78%). Forty-one decedents (41/202; 20%) had been participants in competitive sport. The adjusted odds of dying during physical exertion were higher in men than in women (odds ratio, 4.58; 95% CI, 1.54-13.68; P=0.006) and in competitive athletes in comparison with nonathletes (odds ratio, 16.62; 95% CI, 5.39-51.24; P<0.001). None of the decedents with an antemortem diagnosis of dilated cardiomyopathy fulfilled definite 2010 Task Force criteria. The macroscopic appearance of the heart was normal in 40 of 202 (20%) cases. There was left ventricular histopathologic involvement in 176 of 202 (87%). Isolated right ventricular disease was seen in 13%, isolated left ventricular disease in 17%, and biventricular involvement in 70%. Among whole hearts, the most common areas of fibrofatty infiltration were the left ventricular posterobasal (68%) and anterolateral walls (58%). Postmortem genetic testing yielded pathogenic variants in ACM-related genes in 6 of 24 (25%) decedents. CONCLUSIONS SCD attributable to ACM affects men predominantly, most commonly occurring during exertion in athletic individuals in the absence of previous reported cardiac symptoms. Left ventricular involvement is observed in the vast majority of SCD cases diagnosed with ACM at autopsy. Current Task Force criteria may fail to diagnose biventricular ACM before death.
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Affiliation(s)
- Chris Miles
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Gherardo Finocchiaro
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Belinda Gray
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Joseph Westaby
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Bode Ensam
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Joyee Basu
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Gemma Parry-Williams
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Efstathios Papatheodorou
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Casey Paterson
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Aneil Malhotra
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Jan Lukas Robertus
- Department of Pathology, Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, United Kingdom (J.L.R.)
| | - James S Ware
- National Heart and Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, and Royal Brompton and Harefield NHS Foundation Trust, United Kingdom (J.S.W., S.A.C.)
| | - Stuart A Cook
- National Heart and Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, and Royal Brompton and Harefield NHS Foundation Trust, United Kingdom (J.S.W., S.A.C.)
| | - Angeliki Asimaki
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Adam Witney
- Institute of Infection and Immunity, St George's University of London, United Kingdom (A.W., I.C.S.)
| | - Irina Chis Ster
- Institute of Infection and Immunity, St George's University of London, United Kingdom (A.W., I.C.S.)
| | - Maite Tome
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Elijah R Behr
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
| | - Mary N Sheppard
- Cardiology Clinical Academic Group, St George's University Hospitals' NHS Foundation Trust and Molecular and Clinical Sciences Institute, St George's University of London, United Kingdom (C.M., G.F., M.P., B.G., J.W., B.E., J.B., G.P.-W., E.P. C.P., A.M., A.A., M.T., S.S., E.R.B., M.N.S.)
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6
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Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Predicts Adverse Clinical Outcomes: A Cardiovascular Magnetic Resonance Feature Tracking Study. Sci Rep 2019; 9:14235. [PMID: 31578430 PMCID: PMC6775112 DOI: 10.1038/s41598-019-50535-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate left ventricular (LV) global myocardial strain and LV involvement characteristics in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and to evaluate their predictive value of adverse cardiac events. Sixty consecutive ARVD/C patients with a definite diagnosis of ARVD/C who underwent CMR examination and thirty-four healthy controls were enrolled retrospectively. The CMR images were analyzed for LV myocardial strain and the presence of LV involvement. The endpoint was defined as a composite of sustained ventricular tachycardia or fibrillation, cardiac death, resuscitated cardiac arrest, heart transplantation, and appropriate implantable cardioverter-defibrillator shock. LV global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were significantly impaired in ARVC/D patients compared to healthy controls (GLS: −13.89 ± 3.26% vs. −16.68 ± 2.74%, GCS: −15.65 ± 3.40% vs. −19.20 ± 2.23%, GRS: 34.57 ± 11.98% vs. 49.92 ± 12.59%; P < 0.001 for all). Even in ARVC/D patients with preserved LVEF, LV GLS, GCS and GRS were also significantly reduced than in controls. During a mean follow-up period of 4.10 ± 1.77 years, the endpoint was reached in 17 patients. LV GLS >−12.65% (HR, 3.58; 95%CI, 1.14 to 11.25; p = 0.029) and history of syncope (HR, 4.99; 95%CI, 1.88 to 13.24; p = 0.001) were the only independent predictors of cardiac outcomes. The LV myocardial deformation derived from FT CMR was significantly impaired in ARVD/C patients, and this alteration can occur before the impairment of LVEF. LV GLS >−12.65% and history of syncope were the only independent prognostic markers of adverse cardiac outcomes.
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7
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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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Li GL, Saguner AM, Fontaine GH. Naxos disease: from the origin to today. Orphanet J Rare Dis 2018; 13:74. [PMID: 29747658 PMCID: PMC5946438 DOI: 10.1186/s13023-018-0814-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022] Open
Abstract
Naxos disease, first described by Dr. Nikos Protonotarios and colleagues on the island of Naxos, Greece, is a special form of arrhythmogenic right ventricular dysplasia (ARVD). It is an inherited condition with a recessive form of transmission and a familial penetrance of 90%. It is associated with thickening of the skin of the hands and sole, and a propensity to woolly hair. The cardiac anomalies characterized by ventricular arrhythmias with ventricular extrasystoles and tachycardia and histologic features of the myocardium are consistent with ARVD, but in a more severe form of dysplasia with major dilatation of the right ventricle. The identification of the responsible first gene on chromosome 17, and its product plakoglobin as the responsible protein for Naxos disease proved to be a milestone in the study of ARVD, which opened a new field of research. Thanks to those with the determination to discover Naxos disease, there is and will be more clarity in understanding the mechanisms of juvenile sudden death in the young who have an apparently otherwise normal heart.
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Affiliation(s)
- Guo-Liang Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China. .,Institut de Cardiologie, Unité de Rythmologie, Hôpital Universitaire La Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, France.
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Guy H Fontaine
- Institut de Cardiologie, Unité de Rythmologie, Hôpital Universitaire La Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, France
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Abstract
PURPOSE OF REVIEW The purpose of this review is to present our current understanding of the genetic etiologies that may cause or predispose to heart failure. We highlight known phenotypes for which a genetic evaluation has clinical utility. RECENT FINDINGS The literature continues to demonstrate and confirm a genetic basis for conditions that cause heart failure. Evidence suggests a genetic model involving rare and common variants of strong or weak effect, in combination with environmental factors that may manifest as familial or simplex disease. Clinical genetic testing is available for several phenotypes, which can aid in the diagnosis and identification of at-risk family members. The evaluation of heart failure should include investigating etiologies with a genetic basis. Conducting a genetic evaluation in patients with heart failure requires the ability to identify possible genetic etiologies in an individual's phenotype, obtain relevant family history, and clinically interpret genetic testing results.
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Kalisz K, Rajiah P. Impact of cardiac magnetic resonance imaging in non-ischemic cardiomyopathies. World J Cardiol 2016; 8:132-145. [PMID: 26981210 PMCID: PMC4766265 DOI: 10.4330/wjc.v8.i2.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/23/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Non-ischemic cardiomyopathies include a wide spectrum of disease states afflicting the heart, whether a primary process or secondary to a systemic condition. Cardiac magnetic resonance imaging (CMR) has established itself as an important imaging modality in the evaluation of non-ischemic cardiomyopathies. CMR is useful in the diagnosis of cardiomyopathy, quantification of ventricular function, establishing etiology, determining prognosis and risk stratification. Technical advances and extensive research over the last decade have resulted in the accumulation of a tremendous amount of data with regards to the utility of CMR in these cardiomyopathies. In this article, we review CMR findings of various non-ischemic cardiomyopathies and focus on current literature investigating the clinical impact of CMR on risk stratification, treatment, and prognosis.
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