Diagnostic accuracy of right ventriculography in arrhythmogenic right ventricular cardiomyopathy

Daliento, Luciano; Rizzoli, Giulio; Thiene, Gaetano; Nava, Andrea; Rinuncini, Marco; Chioin, R; Volta, Sergio Dalla

doi:10.1016/0002-9149(90)91141-r

Cited by 97 publications

(33 citation statements)

References 15 publications

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“…All patients underwent invasive study that included left and RV cineangiography (in the right and left anterior oblique views) and coronary angiography as previously reported, 19 EMB, and 3D electroanatomic voltage mapping. An electrophysiological study with programmed ventricular stimulation was performed in 20 patients (65%) clinically presenting with life-threatening ventricular tachyarrhythmias, syncope, or strong family history of sudden death.…”

Section: Invasive Studymentioning

confidence: 99%

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Three-Dimensional Electroanatomic Voltage Mapping Increases Accuracy of Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

et al. 2005

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Background— Three-dimensional electroanatomic voltage mapping offers the potential to identify low-voltage areas that correspond to regions of right ventricular (RV) myocardial loss and fibrofatty replacement in patients with arrhythmogenic RV cardiomyopathy/dysplasia (ARVC/D). Methods and Results— Thirty-one consecutive patients (22 men and 9 women; mean age, 30.8±7 years) who fulfilled the criteria of the Task Force of the European Society of Cardiology and International Society and Federation of Cardiology (ESC/ISFC) for ARVC/D diagnosis after noninvasive clinical evaluation underwent further invasive study including RV electroanatomic voltage mapping and endomyocardial biopsy (EMB) to validate the diagnosis. Multiple RV endocardial, bipolar electrograms (175±23) were sampled during sinus rhythm. Twenty patients (group A; 65%) had an abnormal RV electroanatomic voltage mapping showing ≥1 area (mean 2.25±0.7) with low-voltage values (bipolar electrogram amplitude <0.5 mV), surrounded by a border zone (0.5 to 1.5 mV) that transitioned into normal myocardium (>1.5 mV). Low-voltage electrograms appeared fractionated with significantly prolonged duration and delayed activation. In 11 patients (group B; 35%), electroanatomic voltage mapping was normal, with preserved electrogram voltage (4.4±0.7 mV) and duration (37.2±0.9 ms) throughout the RV. Low-voltage areas in patients from group A corresponded to echocardiographic/angiographic RV wall motion abnormalities and were significantly associated with myocyte loss and fibrofatty replacement at EMB ( P <0.0001) and familial ARVC/D ( P <0.0001). Patients from group B had sporadic disease and histopathological evidence of inflammatory cardiomyopathy ( P <0.0001). During the time interval from onset of symptoms to the invasive study, 11 patients (55%) with electroanatomic low-voltage regions received an implantable cardioverter/defibrillator because of life-threatening ventricular arrhythmias, whereas all but 1 patient with a normal voltage map remained stable on antiarrhythmic drug therapy ( P =0.02). Conclusions— Three-dimensional electroanatomic voltage mapping enhanced accuracy for diagnosing ARVC/D (1) by demonstrating low-voltage areas that were associated with fibrofatty myocardial replacement and (2) by identifying a subset of patients who fulfilled ESC/ISFC Task Force diagnostic criteria but showed a preserved electrogram voltage, an inflammatory cardiomyopathy mimicking ARVC/D, and a better arrhythmic outcome.

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Section: Invasive Studymentioning

confidence: 99%

“…According to a previously reported protocol, 6,19 ventricular wall motion abnormalities were analyzed qualitatively by 2 observers blinded to voltage maps. Interobserver discrepancies were resolved by consensus.…”

Section: Electroanatomic Voltage Mappingmentioning

confidence: 99%

Three-Dimensional Electroanatomic Voltage Mapping Increases Accuracy of Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

et al. 2005

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“…In previous studies, RV volumes and ejection fraction, rather than regional wall motion indices, have been quantified in normal and abnormal states based on angiography [4,5,6,7,8] as well as echocardiography [11] and radionuclide ventriculography [12]. The accuracy of RV volume measurements by contrast angiography is dependent on how contours are defined (manual vs. semiautomated), and while both manual and semiautomated methods have similar precision and variability, each method requires a different calibration as compared with ventricular casts [13].…”

Section: Discussionmentioning

confidence: 99%

“…Previous efforts to quantify normal RV parameters have focused on RV volume and overall ejection fraction [4,5,6,7,8]. Analysis of the RV wall motion is complicated by its complex, asymmetric geometry.…”

Section: Introductionmentioning

confidence: 99%

Do Patients with Right Ventricular Outflow Tract Ventricular Arrhythmias Have a Normal Right Ventricular Wall Motion?

et al. 2005

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Background/Aim: Patients with ventricular ectopy from the right ventricular (RV) outflow tract (RVOT) are often referred for RV angiography to exclude disorders such as arrhythmogenic RV cardiomyopathy/dysplasia (ARVC/D). This is usually based on a qualitative assessment of the wall motion. We present a method to quantify the wall motion and to apply this method to compare patients with RVOT ectopy to normal subjects. Methods: RV angiograms were analyzed from 19 normal subjects and 11 subjects with RVOT ventricular arrhythmias (RVOT arrhythmia subjects) who had no other clinical or other evidence for ARVC/D. By a newly developed computer-based method, RV contours were first traced from multiple frames spanning the entire cardiac cycle. The fractional change in area between contours was then calculated as a serial function of time and location to determine both total contour area change and timing of contour movement. Contour area strain, defined as the differential change in area between nearby regions, was also computed. Results: The contour area change was greatest in the tricuspid valve region and least in the RVOT and midanterior regions. The onset of contraction was earliest in the RVOT region and latest in the apical, inferior, inferoapical, and subtricuspid valve regions. The contour strain was largest in superior tricuspid valve and inferior wall and near zero within the lateral tricuspid valve region. There were significant pairwise differences in contraction area, timing, and strain in the various regions. There were no significant differences between normal subjects and RVOT arrhythmia subjects. Conclusions: The RV wall motion is nonuniform in contour area change, strain, and timing of motion. Patients with RVOT ventricular ectopy demonstrate wall motion parameters similar to those of normal subjects. This technique should be applicable in analyzing RV wall motion in patients suspected of having ARVC/D.

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“…(18,19) RV angiography (RVA) is the imaging gold standard in ARVC and may demonstrate the classical features of localized aneurysms, prominent trabeculations of the RV and global dilation with decreased ejection fraction ( Figure 4). (19,21) Echocardiography, despite being widely available and frequently performed, has a low sensitivity for the detection of ARVC due to the diffi culty of imaging the RV. Despite these shortcomings, it remains useful as the fi rst-line non-invasive imaging modality in assessing both presence of disease at primary evaluation in suspected ARVC and in family screening and also, by means of serial examinations, progression during the follow-up of affected patients.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

The South African Arrhythmogenic Right Ventricular Cardiomyopathy Registry: A brief review and a status report

Hendricks

Mayosi

Okreglicki

2017

SAHJ

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Diagnostic accuracy of right ventriculography in arrhythmogenic right ventricular cardiomyopathy

Cited by 97 publications

References 15 publications

Three-Dimensional Electroanatomic Voltage Mapping Increases Accuracy of Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Three-Dimensional Electroanatomic Voltage Mapping Increases Accuracy of Diagnosing Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Do Patients with Right Ventricular Outflow Tract Ventricular Arrhythmias Have a Normal Right Ventricular Wall Motion?

The South African Arrhythmogenic Right Ventricular Cardiomyopathy Registry: A brief review and a status report

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