Key result
Advanced CMR with T1 mapping reclassifies suspected arrhythmogenic cardiomyopathy as a benign variant in one patient.
Case Report (n=1)
Advanced multimodal imaging, specifically CMR with T1 mapping, is critical for differentiating arrhythmogenic cardiomyopathy from benign anatomical mimics to prevent unnecessary interventions.
Calls for caution diagnosing ACM from epicardial fat and RV dyskinesia; leaves open T1 mapping utility to identify benign variants.
This case report describes a 55-year-old asymptomatic woman with persistent T-wave inversion who was initially suspected of having arrhythmogenic cardiomyopathy (ACM) based on cardiac magnetic resonance findings of epicardial lipomatosis and a dyskinetic right ventricular segment. Advanced CMR with T1 mapping later reclassified the dyskinetic segment as a benign anatomical variant—a “butterfly apex”—and confirmed isolated epicardial fat without myocardial infiltration. Over long-term follow-up, no arrhythmias or structural progression occurred. The case highlights the critical role of multimodal imaging in differentiating ACM from benign anatomical mimics, thereby preventing misdiagnosis and unnecessary intervention.
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Brugiatelli et al. (2026) conducted a case report in Arrhythmogenic cardiomyopathy (n=1). Advanced CMR with T1 mapping was evaluated on Arrhythmias or structural progression. Advanced CMR with T1 mapping reclassified suspected arrhythmogenic cardiomyopathy as a benign anatomical variant in 1 asymptomatic 55-year-old woman, who had 0 arrhythmias over long-term follow-up.
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