Abstract
Purpose of Review
Aim of the paper was to address all strengths and weakness of cardiac magnetic resonance (CMR) in arrhythmogenic cardiomyopathy, trying to highlight areas where further research and investigations should be carried out to fill current gaps in scientific knowledge.
Recent Findings
Arrhythmogenic cardiomyopathy represents a multifaceted clinical entity associated with arrhythmias and sudden death. Even though different diagnostic tools are available for appropriate identification and risk stratification, over the last few years cardiac magnetic resonance (CMR) has surfaced as an unmatched non-invasive imaging tool.
Summary
CMR is mandatory in the evaluation of arrhythmogenic cardiomyopathy. It is the only imaging technique providing the identification of myocardial fibrosis, particularly for left ventricular myocardium, as recent evidences demonstrated that left ventricular involvement in arrhythmogenic cardiomyopathy is associated with greater risk of sudden death than lone right ventricular involvement.
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• Sen-Chowdhry S, Prasad SK, Syrris P, Wage R, Ward D, Merrifield R, et al. Cardiovascular magnetic resonance in arrhythmogenic right ventricular cardiomyopathy revisited: comparison with task force criteria and genotype. J Am Coll Cardiol. 2006;48:2132–40. This study was the first showing the role of magnetic resonance in arrhythmogenic cardiomyopathy.
Gotschy A, Saguner AM, Niemann M, Hamada S, Akdis D, Yoon J-N, et al. Right ventricular outflow tract dimensions in arrhythmogenic right ventricular cardiomyopathy/dysplasia-a multicentre study comparing echocardiography and cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging. 2018;19:516–23.
• Protonotarios N, Anastasakis A, Antoniades L, Chlouverakis G, Syrris P, Basso C, et al. Arrhythmogenic right ventricular cardiomyopathy/dysplasia on the basis of the revised diagnostic criteria in affected families with desmosomal mutations. Eur Heart J. 2011, 32:1097–104. This study demonstrated the evolving characteristics of ARVD.
Borgquist R, Haugaa KH, Gilljam T, Bundgaard H, Hansen J, Eschen O, et al. The diagnostic performance of imaging methods in ARVC using the 2010 Task Force criteria. Eur Heart J Cardiovasc Imaging. 2014;15:1219–25.
Aquaro GD, Camastra G, Monti L, Lombardi M, Pepe A, Castelletti S, et al. Reference values of cardiac volumes, dimensions, and new functional parameters by MR: a multicenter, multivendor study. J Magn Reson Imaging. 2017;45:1055–67.
Aquaro GD, Todiere G, Strata E, Barison A, Di Bella G, Lombardi M. Usefulness of India ink artifact in steady-state free precession pulse sequences for detection and quantification of intramyocardial fat. J Magn Reson Imaging. 2014;40:126–32.
Aquaro GD, Nucifora G, Pederzoli L, Strata E, De Marchi D, Todiere G, et al. Fat in left ventricular myocardium assessed by steady-state free precession pulse sequences. Int J Card Imaging. 2012;28:813–21.
• Aquaro GD, Barison A, Todiere G, Grigoratos C, Ait Ali L, Di Bella G, et al. Usefulness of combined functional assessment by cardiac magnetic resonance and tissue characterization versus Task Force Criteria for diagnosis of arrhythmogenic right ventricular cardiomyopathy. Am J Cardiol. 2016;118:1730–6. This study demonstrated the diagnostic role of tissue characterization by cardiac magnetic resonance.
Tandri H, Saranathan M, Rodriguez ER, Martinez C, Bomma C, Nasir K, et al. Noninvasive detection of myocardial fibrosis in arrhythmogenic right ventricular cardiomyopathy using delayed-enhancement magnetic resonance imaging. J Am Coll Cardiol. 2005;45:98–103.
Etoom Y, Govindapillai S, Hamilton R, Manlhiot C, Yoo S-J, Farhan M, et al. Importance of CMR within the Task Force Criteria for the diagnosis of ARVC in children and adolescents. J Am Coll Cardiol. 2015;65:987–95.
Bourfiss M, Prakken NHJ, van der Heijden JF, Kamel I, Zimmerman SL, Asselbergs FW, et al. Diagnostic value of native T1 mapping in arrhythmogenic right ventricular cardiomyopathy. JACC Cardiovasc Imaging. 2019;12:1580–2.
Czimbalmos C, Csecs I, Dohy Z, Toth A, Suhai FI, Müssigbrodt A, et al. Cardiac magnetic resonance based deformation imaging: role of feature tracking in athletes with suspected arrhythmogenic right ventricular cardiomyopathy. Int J Card Imaging. 2019;35:529–38.
Zghaib T, Ghasabeh MA, Assis FR, Chrispin J, Keramati A, Misra S, et al. 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. 2018;11:e007546.
Liu T, Pursnani A, Sharma UC, Vorasettakarnkij Y, Verdini D, Deeprasertkul P, et al. Effect of the 2010 task force criteria on reclassification of cardiovascular magnetic resonance criteria for arrhythmogenic right ventricular cardiomyopathy. J Cardiovasc Magn Reson. 2014;16:47.
D’Ascenzi F, Solari M, Corrado D, Zorzi A, Mondillo S. Diagnostic differentiation between arrhythmogenic cardiomyopathy and athlete’s heart by using imaging. JACC Cardiovasc Imaging. 2018;11:1327–39.
Luijkx T, Velthuis BK, Prakken NHJ, Cox MGPJ, Bots ML, Mali WPTM, et al. Impact of revised Task Force Criteria: distinguishing the athlete’s heart from ARVC/D using cardiac magnetic resonance imaging. Eur J Prev Cardiol. 2012;19:885–91.
Hauer RNW. Cardiac sarcoidosis mimicking definite arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm. 2020;
Steckman DA, Schneider PM, Schuller JL, Aleong RG, Nguyen DT, Sinagra G, et al. Utility of cardiac magnetic resonance imaging to differentiate cardiac sarcoidosis from arrhythmogenic right ventricular cardiomyopathy. Am J Cardiol. 2012;110:575–9.
Cipriani A, Bauce B, De Lazzari M, Rigato I, Bariani R, Meneghin S, et al. Arrhythmogenic right ventricular cardiomyopathy: characterization of left ventricular phenotype and differential diagnosis with dilated cardiomyopathy. J Am Heart Assoc. 2020;9:e014628.
Aquaro GD, Pingitore A, Strata E, Di Bella G, Molinaro S, Lombardi M. Cardiac magnetic resonance predicts outcome in patients with premature ventricular complexes of left bundle branch block morphology. J Am Coll Cardiol. 2010;56:1235–43.
Aquaro GD, Pingitore A, Di Bella G, Piaggi P, Gaeta R, Grigoratos C, et al. Prognostic role of cardiac magnetic resonance in arrhythmogenic right ventricular cardiomyopathy. Am J Cardiol. 2018;122:1745–53.
• Aquaro GD, De Luca A, Cappelletto C, Raimondi F, Bianco F, Botto N, et al. Prognostic value of magnetic resonance phenotype in patients with arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol. 2020;75:2753–65. This is the first study demonstrating that left ventricular involvement in ARVC is more arrhythmogenic than lone right ventricular involvement.
Rastegar N, Burt JR, Corona-Villalobos CP, Te Riele AS, James CA, Murray B, et al. Cardiac MR findings and potential diagnostic pitfalls in patients evaluated for arrhythmogenic right ventricular cardiomyopathy. Radiographics. 2014;34:1553–70.
Cox MGPJ, van der Smagt JJ, Noorman M, Wiesfeld AC, Volders PGA, van Langen IM, et al. Arrhythmogenic right ventricular dysplasia/cardiomyopathy diagnostic task force criteria: impact of new task force criteria. Circ Arrhythm Electrophysiol. 2010;3:126–33.
Klopotowski M, Kukula K, Malek LA, Spiewak M, Polanska-Skrzypczyk M, Jamiolkowski J, et al. The value of cardiac magnetic resonance and distribution of late gadolinium enhancement for risk stratification of sudden cardiac death in patients with hypertrophic cardiomyopathy. J Cardiol. 2016;68:49–56.
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Grigoratos, C., Aquaro, G.D. The Role of Cardiovascular Magnetic Resonance in ARVC. Curr Cardiol Rep 23, 56 (2021). https://doi.org/10.1007/s11886-021-01488-1
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DOI: https://doi.org/10.1007/s11886-021-01488-1