The echocardiographic assessment of the right ventricle in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia compared with athletes and matched controls

Abstract

Background There are discrepancies in the quantitative echocardiographic criteria for the right ventricle (RV) between the revised task force criteria (TFC) for Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) and the guidelines for RV assessment endorsed by American Society of Echocardiography (ASE). Importantly, these criteria do not take into account potential adaptation of the RV to exercise. The goal of this study was to compare the revised TFC quantitative echocardiographic parameters in patients with ARVC/D, athletes and matched controls. Methods Echocardiographic parameters of the RV were retrospectively collected in patients who fulfilled the TFC for ARVC/D, an age‐ matched, sex‐matched, and body surface area‐matched control population, and athletes (defined as individuals who exercised for more than 7 hours per week). Patients with structural heart disease were excluded in the control and athlete groups. Results Twenty patients with ARVC/D, 11 athletes and 20 matched controls were included. There was no significant difference between ARVC/D patients and athletes with the exception of the parasternal long axis right ventricular outflow tract diameter. All parameters were significantly different between ARVC/D patients and the control group. Furthermore, when subjects were categorized into meeting 1 major revised TFC/abnormal ASE criteria or not, only ASE criteria were able to differentiate ARVC/D from control population. Both were unable to differentiate ARVC/D from athletes. Conclusions Right ventricle quantitative echocardiographic criteria in the revised TFC are not specific for ARVC/D. Care should be taken in applying these criteria in athletes.

Clinical and Genetic Characteristics of Arrhythmogenic Right Ventricular Cardiomyopathy Patients: A Single-Center Experience

“…The echocardiogram is a beneficial, non-invasive diagnostic test to assess structural changes in ARVC [ 38 - 40 ]. Echocardiogram changes meeting major diagnostic criteria present in 39% of our patients.…”

A Novel Diagnostic Score Integrating Atrial Dimensions to Differentiate between the Athlete’s Heart and Arrhythmogenic Right Ventricular Cardiomyopathy

“…There is a significant overlap between myocardial RV morphologic alterations described in ARVC and the athlete’s heart [ 5 , 6 , 7 ]. The revised 2010 TFC were developed in order to improve the diagnosis of ARVC.…”

“…Until now, observational echocardiographic studies reported contrasting findings for cardiac function and dimensions in athletes compared to ARVC [ 5 , 6 , 7 ]. Data about the physiological exercise-induced alterations involving the right atrium (RA) in athletes compared to patients with ARVC is scarce.…”

Multimodality imaging in arrhythmogenic cardiomyopathy

“…Other CMR studies reported a prevalence of ACM mimics between 4.4% and 5% 21,22 . In a small study that included 51 patients (20 with ACM, 11 athletes and 20 controls), echocardiographic criteria as established by both TFC and ASE, were not able to differentiate between ACM patients and athletes 23 . Another study that compared 34 healthy athletes with 34 ACM patients and 8 trained athletes with ACM using CMR, aimed to assess the diagnostic effi ciency of RV end-diastolic volume (RVEDV) and RV EF and the additional value of strain analysis.…”