Role of myocardial T1 mapping in arrhythmogenic right ventricular cardiomyopathy

Background

T1 mapping by cardiovascular magnetic resonance (CMR) is an accurate tool to assess myocardial extracellular space with wider clinical applications in the aetiological characterization of cardiomyopathies. The aims of the study were to explore a possible role of myocardial T1 mapping in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and in first-degree relatives at risk and to investigate the possible relationship between left ventricular (LV) involvement at CMR and ECG features.

Methods

Thirty patients with ARVC (47% males, mean age 42±22 years) and 59 first-degree relatives who did not fulfil ARVC diagnostic Task Force criteria, underwent full diagnostic work-up including CMR with native and post-contrast T1 mapping.

Results

The CMR was abnormal in 26 (86%) patients with ARVC. The RV was affected in isolation in 13 (43%) patients. Prior to T1 mapping assessment, 2 (7%) patients exhibited isolated LV involvement and 11 (36%) patients showed features of biventricular disease. Left ventricular involvement was manifested as detectable LV late gadolinium enhancement (LGE) in 12 out of 13 cases. According to pre-specified septal T1 mapping thresholds, 11 (37%) patients showed abnormally high native T1 values. Myocardial T1 mapping was higher than normal in 5 (17%) patients who would have been classified as exhibiting a normal LV by conventional imaging. The proportion of patients with abnormal T1 values was similar in patients with or without LGE. Myocardial T1 mapping was higher than normal in 22 (37%) of the 59 first-degree relatives.

Conclusions

Native and/or post contrast myocardial T1 values are raised in almost half of patients with ARVC and in a similar proportion of unaffected first-degree relatives. T1 mapping offers the potential for early detection of LV involvement in patients with ARVC and in first-degree relatives at risk.

Funding Acknowledgement

Type of funding source: None

Corrected ASD: case closed?

Ellis-van Creveld syndrome (EvC) is a rare autosomal recessive chondroectodermal dysplasia, associated with mutations in the EVC1 and EVC2 genes (4p16). The management of EvC is multidisciplinary, and early diagnosis is of the utmost importance for efficient and timely treatment. The main prognostic determinant is presence of a heart defect. The authors describe the case of a 42-year-old man referred to our outpatient cardiology clinic, following surgical repair of an atrial septal defect. He had presented to different medical specialties on numerous occasions since childhood, but remained without a clear diagnosis for more than 40 years. This case reinforces the need for a holistic view when assessing a patient with congenital heart disease. Moreover, this illustrates the importance of communication and discussion between different medical specialties.