Arrhythmogenic right ventricular dysplasia: MR features

Midiri, Massimo; Finazzo, M; Brancato, M.; Hoffmann, Enrico; Indovina, G; Maria, Marcello De; Lagalla, Roberto

doi:10.1007/s003300050155

Cited by 91 publications

(71 citation statements)

References 15 publications

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“…In particular, fat is depicted with high signal intensity on T 1 -weighted MR images, whereas the myocardium has an intermediate signal. The presence of myocardial fat identified by MR imaging has been reported to be strongly associated with ARVC/D [5, 7, 8, 9, 10, 11, 12]. The reliability and interobserver agreement of these MR imaging features, however, has never been evaluated in a multi-center trial.…”

Section: Introductionmentioning

confidence: 99%

“…MR imaging is often used in the diagnostic evaluation of ARVC/D because it is noninvasive and readily depicts morphologic abnormalities of the RV, including right ventricular chamber size or aneurysm, as well as functional abnormalities of the RV using MR cine techniques [7, 8, 9, 10, 11, 12]. MR cine images, however, lack standardization and many MR centers do not have the capability to transmit or display cine images for purposes of referral to tertiary medical centers.…”

Section: Introductionmentioning

confidence: 99%

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MR Imaging of Arrhythmogenic Right Ventricular Cardiomyopathy: Morphologic Findings and Interobserver Reliability

et al. 2003

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Background: Magnetic resonance (MR) imaging is frequently used to diagnose arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, the reliability of various MR imaging features for diagnosing ARVC/D is unknown. The purpose of this study was to determine which morphologic MR imaging features have the greatest interobserver reliability for diagnosing ARVC/D. Methods: Forty-five sets of films of cardiac MR images were sent to 8 radiologists and 5 cardiologists with experience in this field. There were 7 cases of definite ARVC/D as defined by the Task Force criteria. Six cases were controls. The remaining 32 cases had MR imaging because of clinical suspicion of ARVC/D. Readers evaluated the images for the presence of (a) right ventricle (RV) enlargement, (b) RV abnormal morphology, (c) left ventricle enlargement, (d) presence of high T₁ signal (fat) in the myocardium, and (e) location of high T₁ signal (fat) on a Likert scale with formatted responses. Results: Readers indicated that the Task Force ARVC/D cases had significantly more (χ² = 119.93, d.f. = 10, p < 0.0001) RV chamber size enlargement (58%) than either the suspected ARVC/D (12%) or no ARVC/D (14%) cases. When readers reported the RV chamber size as enlarged they were significantly more likely to report the case as ARVC/D present (χ²⁼33.98, d.f. = 1, p < 0.0001). When readers reported the morphology as abnormal they were more likely to diagnose the case as ARVC/D present (χ² = 78.4, d.f. = 1, p < 0.0001), and the Task Force ARVC/D (47%) cases received significantly more abnormal reports than either suspected ARVC/D (20%) or non-ARVC/D (15%) cases. There was no significant difference between patient groups in the reported presence of high signal intensity (fat) in the RV (χ² = 0.9, d.f. = 2, p > 0.05). Conclusions: Reviewers found that the size and shape of abnormalities in the RV are key MR imaging discriminates of ARVD. Subsequent protocol development and multicenter trials need to address these parameters. Essential steps in improving accuracy and reducing variability include a standardized acquisition protocol and standardized analysis with dynamic cine review of regional RV function and quantification of RV and left ventricle volumes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

MR Imaging of Arrhythmogenic Right Ventricular Cardiomyopathy: Morphologic Findings and Interobserver Reliability

et al. 2003

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“…CMR is highly sensitive for detecting intramyocardial fibrofatty changes typical of ARVC (28), and may be superior to TTE, especially when strict imaging criteria are adhered to (29). However, there is marked interobserver variability for abnormal CMR findings (29). The most characteristic echocardiography findings are increased RV outflow tract dimensions and abnormal RV morphology (30).…”

Section: How Do I Diagnose It?mentioning

confidence: 99%

“…TTE and CMR are the imaging modalities of choice. CMR is highly sensitive for detecting intramyocardial fibrofatty changes typical of ARVC (28), and may be superior to TTE, especially when strict imaging criteria are adhered to (29). However, there is marked interobserver variability for abnormal CMR findings (29).…”

Section: How Do I Diagnose It?mentioning

confidence: 99%

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials

Howlett¹,

McKelvie²,

Arnold³

et al. 2009

Canadian Journal of Cardiology

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The Canadian Cardiovascular Society published a comprehensive set of recommendations on the diagnosis and management of heart failure in January 2006. Based on feedback obtained through a national program of heart failure workshops and through active solicitation of stakeholders, several topics were identified because of their importance to the practicing clinician. Topics chosen for the present update include best practices for the diagnosis and management of right-sided heart failure, myocarditis and device therapy, and a review of recent important or landmark clinical trials. These recommendations were developed using the structured approach for the review and assessment of evidence adopted and previously described by the Society. The present update has been written from a clinical perspective to provide a user-friendly and practical approach. Specific clinical questions that are addressed include: What is right-sided heart failure and how should one approach the diagnostic work-up? What other clinical entities may masquerade as this nebulous condition and how can we tell them apart? When should we be concerned about the presence of myocarditis and how quickly should patients with this condition be referred to an experienced centre? Among the myriad of recently published landmark clinical trials, which ones will impact our standards of clinical care? The goals are to aid physicians and other health care providers to optimally treat heart failure patients, resulting in a measurable impact on patient health and clinical outcomes in Canada.

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“…Echocardiography often misses subtle abnormalities of the RV wall motion particularly in the early stages of the disease. Cardiac magnetic resonance imaging (CMR) is recognized as an important imaging tool to aid in the diagnosis of the disease given its ability to visualize the RV walls, in multiple plans and three-dimensionally, without the limitations seen with echocardiography, and accurately quantify volumes and ejection fraction (with high reproducibility) [21][22] . The 2010 revised Task Force Criteria includes minor and major CMR parameters for regional RV dysfunction, volumes, and global systolic dysfunction with sensitivity and specificity of 79% and 85% in men, and 89% and 97% in women, respectively 23 .…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Are premature ventricular contractions in patients without apparent structural heart disease really safe?

Jazra¹,

Wazni²,

Jaroudi³

2015

ICFJ

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Premature ventricular complexes (PVC) are considered benign when they occur in patients without apparent structural heart disease. They usually originate from the right, or less commonly, left ventricular outflow tract. Their suppression was not beneficial in patients with heart disease like myocardial infarction and cardiomyopathies. Recently it has been shown that their suppression medically or by ablation, improved the left ventricular (LV) dysfunction. This led to the hypothesis that they may contribute to this LV dysfunction especially when they are particularly frequent (> 20000 per day). Because of some overlap with arrhythmogenic right ventricular dysplasia, the evaluation in patients without apparent heart disease should consider an magnetic resonance imaging if the echocardiography was not able to help in diagnosis especially when there is a suspicion.Patients without structural heart disease and low-to modest PVC burdens do not always require treatment.When necessary, treatment for PVCs involves beta-blockers, calcium channel blockers, or other antiarrhythmicdrugs and catheter ablation in selected cases. Catheter ablation can be curative, but it is typically reservedfor drug-intolerant or medically refractory patients with a high PVC burden.

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Arrhythmogenic right ventricular dysplasia: MR features

Cited by 91 publications

References 15 publications

MR Imaging of Arrhythmogenic Right Ventricular Cardiomyopathy: Morphologic Findings and Interobserver Reliability

MR Imaging of Arrhythmogenic Right Ventricular Cardiomyopathy: Morphologic Findings and Interobserver Reliability

Canadian Cardiovascular Society Consensus Conference guidelines on heart failure, update 2009: Diagnosis and management of right-sided heart failure, myocarditis, device therapy and recent important clinical trials

Are premature ventricular contractions in patients without apparent structural heart disease really safe?

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