Cardiac magnetic resonance based deformation imaging: role of feature tracking in athletes with suspected arrhythmogenic right ventricular cardiomyopathy

Abstract

Both, arrhythmogenic right ventricular cardiomyopathy (ARVC) and regular training are associated with right ventricular (RV) remodelling. Cardiac magnetic resonance (CMR) is given an important role in the diagnosis of ARVC in current task force criteria (TFC), however, they contain no cut-off values for athletes. We aimed to confirm the added value of feature tracking and to provide new cut-off values to differentiate between ARVC and athlete’s heart. Healthy athletes with training of minimal 15 h/week (n = 34), patients with definite ARVC (n = 34) and highly trained athletes with ARVC (n = 8) were examined by CMR. Left and right ventricular volumes and masses were determined. Global right and left ventricular, and regional strain analysis for the RV free wall was performed using feature tracking on balanced steady-state free precession cine images. 94% of healthy athletes showed RV dilatation of the proposed TFC, 14.7% showed RV ejection fraction (RVEF) between 45–50%, none of them had RVEF < 45%. Although RVEF showed the highest accuracy in differentiating between athlete’s heart and ARVC, only 37.5% of athletes with ARVC showed RVEF < 45%. The only parameters falling in the pathological range (based on our established cut-off values: > − 25.6 and > − 1.4, respectively) in all athletes with ARVC were the strain and strain rate of the midventricular RV free wall. Establishing RVEF and RV strain analysis provides an important tool to distinguish ARVC from athlete’s heart. CMR based regional strain and strain rate values may help to identify ARVC even in highly trained athletes with preserved RVEF.

The impact of sex, age and training on biventricular cardiac adaptation in healthy adult and adolescent athletes: Cardiac magnetic resonance imaging study

“…30 Physiological adaptation of the athlete’s right ventricle may overlap with pathological features observed in ARVC, thus differentiating physiological adaptation from ARVC could be challenging. 31,32 Calculating the RV/LV volume ratio is a quick and reliable method to determine the imbalances of biventricular adaptation. Based on literature data, the RVEDV/LVEDV value of 1.3 could suggest pathological right ventricular dilation.…”

Partitioning the Right Ventricle Into 15 Segments and Decomposing Its Motion Using 3D Echocardiography-Based Models: The Updated ReVISION Method

“…Concerning the LV, standardized segmentation is widely performed in different cardiovascular imaging modalities mainly to correlate regional dysfunction with coronary perfusion territories (14) or to appreciate and quantify distinct patterns in LV myocardial function, which could be a characteristic of certain pathological processes (15). The same applies to the RV, as pulmonary hypertension or arrhythmogenic cardiomyopathy are just two clinical examples among several others, where established regional dysfunction exists (1,16,17). Nevertheless, only a few options are available for the comprehensive and quantitative assessment of the regional RV function due to its complex 3D shape and mechanics.…”

Absence of ECG Task Force Criteria does not rule out structural changes in genotype positive ARVC patients

“…Also, with increasing awareness of ARVC and improved availability and better resolution of cardiac imaging techniques, there may now even be a risk of over-diagnosing ARVC [15]. E.g., in competitive athletes, a substantial proportion fulfills ARVC imaging criteria with dilation of RVOT without fulfilling TFC for ARVC [16][17][18]. As our study shows, improved diagnostic tools to identify true ARVC are highly needed.…”