Regional Strain by Cardiac Magnetic Resonance Imaging Improves Detection of Right Ventricular Scar Compared With Late Gadolinium Enhancement on a Multimodality Scar Evaluation in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy.
Circ Cardiovasc Imaging
; 11(9): e007546, 2018 09.
Article
em En
| MEDLINE
| ID: mdl-30354675
ABSTRACT
BACKGROUND:
Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy characterized by fibrofatty replacement of right ventricular myocardium resulting in reentrant ventricular tachycardia (VT). Cardiac magnetic resonance imaging (CMR) can noninvasively measure regional abnormalities using tissue-tracking strain as well as late gadolinium enhancement (LGE). In this study, we examine arrhythmogenic substrate using regional CMR strain, LGE, and electroanatomic mapping (EAM) in arrhythmogenic right ventricular cardiomyopathy patients presenting for VT ablation. METHODS ANDRESULTS:
Twenty-one patients underwent right ventricular endocardial EAM, whereas 17 underwent epicardial EAM, to detect dense scar (<0.5 mV) as well as CMR study within 12 months. Quantitative regional strain analysis was performed in all 21 patients, although the presence of LGE was visually examined in 17 patients. Strain was lower in segments with dense scar on endocardial and epicardial EAM (-9.7±4.1 versus -7.3±4.0, and -9.8±2.8 versus -7.6±3.8; P<0.05), in segments with LGE scar (-9.9±4.4 versus -6.0±3.6; P=0.001), and at VT culprit sites (-7.4±3.7 versus -10.1±4.1; P<0.001), compared with the rest of right ventricular. On patient-clustered analysis, a unit increase in strain was associated with 21% and 18% decreased odds of scar on endocardial and epicardial EAM, respectively, 17% decreased odds of colocalizing VT culprit site, and 43% decreased odds of scar on LGE-CMR ( P<0.05 for all). LGE and EAM demonstrated poor agreement with κ=0.18 (endocardial, n=17) and κ=0.06 (epicardial, n=13). Only 8 (15%) VT termination sites exhibited LGE.CONCLUSIONS:
Regional myocardial strain on cine CMR improves detection of arrhythmogenic VT substrate compared with LGE. This may enhance diagnostic accuracy of CMR in arrhythmogenic right ventricular cardiomyopathy without the need for invasive procedures and facilitate the planning of VT ablation procedures.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Função Ventricular Direita
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Imagem Cinética por Ressonância Magnética
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Meios de Contraste
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Displasia Arritmogênica Ventricular Direita
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Gadolínio DTPA
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Ventrículos do Coração
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Contração Miocárdica
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Miocárdio
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
Idioma:
En
Revista:
Circ Cardiovasc Imaging
Assunto da revista:
ANGIOLOGIA
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CARDIOLOGIA
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DIAGNOSTICO POR IMAGEM
Ano de publicação:
2018
Tipo de documento:
Article