Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy/dysplasia: comparison of three-dime
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POSTER PRESENTATION
Open Access
Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy/ dysplasia: comparison of three-dimensional electroanatomic voltage mapping and contrastenhanced cardiac magnetic resonance Martina Perazzolo Marra1*, Loira Leoni1, Barbara Bauce1, Alessandro Zorzi1, Manuel De Lazzari1, Francesco Corbetti2, Luisa Cacciavillani1, Ilaria Rigato1, Federico Migliore1, Maria Silvano1, Cristina Basso3, Francesco Tona1, Gianfranco Buja1, Gaetano Thiene3, Sabino Iliceto1, Domenico Corrado1 From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Introduction The hallmark lesion of arrhythmogenic right ventricular cardiomyopathy (ARVC/D) is the RV myocardial loss with replacement by fibrofatty tissue. Emerging tools offer the possibility to directly visualize fibrofatty ventricular scar. electroanatomic voltage mapping (EVM) by CARTO system has been demonstrated to identify lowvoltage myocardial areas (“electroanatomic scar”, EAS) invasively, whereas contrast-enhanced cardiac magnetic resonance CE-CMR has the potential to detect regions of delayed contrast-enhancement (“DCE scar”) noninvasively. Purpose The aim of the present study was to compare EVM and CE-CMR for imaging scar lesion in ARVC/D patients. Methods 23 consecutive patients (16 males and 7 females; mean age 38±12 yrs) with a clinical diagnosis of ARVC/D who additionally underwent both RV EVM and CE-CMR. Analysis of RV free wall regions for scar location included the RV outflow tract (RVOT), the anterolateral region, the infero-basal region and the apex.
1 Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy Full list of author information is available at the end of the article
Results RV EVM was abnormal in 21/23 (91%) patients, with a total of 45 EAS: 17 (38%) in the infero-basal region, 12 (26.6%) in the antero-lateral region, 8 (17.7%) in the RV outflow tract (RVOT) and 8 (17.7%) in the apex. RV DCE was found in 9/23 (39%) patients with a total of 23 RV DCE scars: 4 (17.4%) in the infero-basal region, 9 (39.1%) in the antero-lateral region, 4 (17.4%) in the RVOT and 6 (26.1%) in the apex. Comparative analysis showed a mismatch in 24 RV scar areas, with 22 EAS not confirmed by the DCE (13 in the infero-basal region, 3 in antero-lateral region, 4 in RVOT and 2 on apex), and 2 DCE scars (both in the RVOT) undetected by the EVM. In 9/12 (75%) patients with abnormal RV EVM/normal RV DCE, ≥ 1 DCE were identified in the left ventricular (LV) free wall or interventricular septum, which affected the subepicardial/midmural layers. Overall, ventricular DCE was detected by CE-CMR in 78% of ARVC/D patients. Conclusions EVM and CE-CMR allow identification of RV scar lesions in the majority of ARVC/D patients, although a mismatch between the two techniques was found with fewer RV scars identified by CE-CMR. The high prevalence of LV DCE in ARVC/D patients with abnormal RV-EVM/normal RV-DCE confirms the frequent
© 2011 Marra et al; licensee BioMed Central Ltd.
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