CLINICAL RESEARCH: CARDIAC MAGNETIC RESONANCE
Noninvasive detection of myocardial fibrosis in arrhythmogenic right ventricular cardiomyopathy using delayed-enhancement magnetic resonance imaging
Harikrishna Tandri, MD*,
Manoj Saranathan, PhD ,
E. Rene Rodriguez, MD*,
Claudia Martinez, MD*,
Chandra Bomma, MD*,
Khurram Nasir, MBBS*,
Boas Rosen, MD*,
João A.C. Lima, MD*,
Hugh Calkins, MD* and
David A. Bluemke, MD, PhD*,
* Division of Cardiology
Department of Radiology, The Johns Hopkins University, Baltimore, Maryland
Manuscript received April 10, 2004;
revised manuscript received September 17, 2004,
accepted September 21, 2004.
* Reprint requests and correspondence: Dr. David A. Bluemke, MRI Building, Room 143, Department of Radiology, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, Maryland 21287 (Email: dbluemke{at}jhmi.edu).
OBJECTIVES: We evaluated the role of myocardial delayed-enhancement (MDE) magnetic resonance imaging (MRI) for noninvasive detection of fibrosis in Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).
BACKGROUND: Arrhythmogenic right ventricular dysplasia/cardiomyopathy is characterized by fibro-fatty replacement of the right ventricle (RV) leading to arrhythmias and RV failure. Endomyocardial biopsy can demonstrate fibro-fatty replacement of the RV myocardium; however, the test is invasive and carries a risk of perforation.
METHODS: Thirty consecutive patients were prospectively evaluated for ARVD/C. Magnetic resonance imaging was performed on a 1.5-T scanner. Ten minutes after intravenous administration of 0.2 mmol/kg of gadodiamide, MDE-MRI was obtained. Diagnosis of ARVD/C was based upon the Task Force criteria and did not include MRI findings.
RESULTS: Twelve (40%) of 30 patients met the Task Force criteria for ARVD/C. Eight (67%) of the 12 ARVD/C patients demonstrated increased signal on MDE-MRI in the RV compared with none (0%) of the 18 patients without ARVD/C (p < 0.001). Endomyocardial biopsy was performed in 9 of the 12 ARVD/C patients. Of the nine patients, four had fibro-fatty changes consistent with the diagnosis of ARVD/C. Each of these patients had increased RV signal on MDE-MRI. None of the patients without ARVD/C had any abnormalities either on histopathology or on MDE-MRI. Electrophysiologic testing revealed inducible sustained ventricular tachycardia (VT) in six of the eight ARVD/C patients with delayed enhancement, compared with none of the ARVD/C patients without delayed enhancement (p = 0.01).
CONCLUSIONS: Noninvasive detection of RV myocardial fibro-fatty changes in ARVD/C is possible by MDE-MRI. Magnetic resonance imaging findings had an excellent correlation with histopathology and predicted inducible VT on programmed electrical stimulation, suggesting a possible role in evaluation and diagnosis of patients with suspected ARVD/C.
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Abbreviations and Acronyms
| | ARVD/C = arrhythmogenic right ventricular dysplasia/cardiomyopathy | | CNR = contrast-to-noise ratio | | ECG = electrocardiogram | | EP = electrophysiologic | | FOV = field of view | | LBBB = left bundle branch block | | MDE = myocardial delayed enhancement | | MRI = magnetic resonance imaging | | ROI = region of interest | | RV = right ventricle | | RVEDV = right ventricular end diastolic volume | | RVEF = right ventricular ejection fraction | | RVOT = right ventricular outflow tract | | VT = ventricular tachycardia |
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