December 1, 1996Open Access
Spin-echo nuclear magnetic resonance for tissue characterisation in arrhythmogenic right ventricular cardiomyopathy.
Key Result
Spin-echo nuclear magnetic resonance detected abnormal fatty replacement with 67% sensitivity in ARVC patients and 100% specificity in matched controls.
Study Design
Type
Case-Control (n=23)
Structured PICO
Does spin-echo NMR accurately detect fatty replacement in patients with ARVC?
P
Population
23 subjects (15 men, 8 women, aged 18-49, mean 34), including 15 with a clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) and 8 age- and sex-matched controls.
I
Intervention
Spin-echo T1-weighted nuclear magnetic resonance (NMR) and multislice scan
C
Comparator
Age and sex matched controls; endomyocardial biopsy in a subset of 9 patients
O
Outcome
Diagnostic accuracy (sensitivity and specificity) of NMR for detecting fatty replacementsurrogate
Spin-echo NMR is a useful non-invasive diagnostic tool with high specificity but moderate sensitivity for detecting fatty replacement in ARVC.
Main Result
Absolute Event Rate: 66.7% vs 0%
Abstract
OBJECTIVE: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a myocardial disorder characterised clinically by ventricular arrhythmias that can cause cardiac arrest and morphologically by fatty or fibro-fatty myocardial atrophy of the right ventricle. In vivo tissue characterisation without endomyocardial biopsy would be useful. The aim of this study was to investigate the diagnostic accuracy of spin-echo nuclear magnetic resonance (NMR) for tissue characterisation in ARVC. PATIENTS AND METHODS: Twenty three subjects (15 men and eight women, aged 18-49, mean 34) were studied with spin-echo T1-weighted NMR and multislice scan. Fifteen had a clinical diagnosis of ARVC and eight were controls (age and sex matched subjects). Data were independently evaluated by two expert observers. RESULTS: In the control group NMR was always negative (100% specificity). Ten of the 15 patients with ARVC had an abnormal NMR result (67% sensitivity), with areas that had a signal intensity close to that of pericardial or subcutaneous fat. In the remaining five cases the NMR signal was inadequate. Nine patients underwent both NMR and endomyocardial biopsy; biopsy was positive in eight (89%) and NMR was positive in five (56%). CONCLUSIONS: NMR is a useful non-invasive diagnostic tool in the evaluation of fatty replacement in ARVC. The technique can be used with other procedures in the initial diagnostic evaluation and is a useful alternative tool in the long term follow up of patients with ARVC.