Cardiovascular magnetic resonance imaging volume criteria for arrhythmogenic right ventricular cardiomyopathy: need for update?

This commentary refers to ‘Arrhythmogenic right ventricular cardiomyopathy: evaluation of the current diagnostic criteria and differential diagnosis’, by D. Corrado et al., 2020;41:1414–1427. We would like to thank the authors of the International Expert Report for the critical appraisal of the 2010 International Task Force criteria for diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC).1 As highlighted by the authors, although cardiovascular magnetic resonance (CMR) imaging has become the gold standard for assessment of ventricular volumes, certain limitations still exist particularly for the right ventricle, including interobserver variation in the evaluation of regional wall motion abnormalities and lack of sensitivity and specificity. Importantly, the 2010 ARVC task force criteria were developed largely based on the older gradient echo-cine CMR sequence, which is known to underestimate volumes due to lower/incomplete endocardial border definition.2 , 3 Therefore, the current CMR right ventricular volume cut-offs used by the ARVC Task Force for major [ratio of right ventricular (RV) end-diastolic volume to body surface area (BSA) ≥110 mL/m2 (male) or ≥100 mL/m2 (female)] and minor criteria [ratio of RV end-diastolic volume to BSA ≥100 to <110 mL/m2 (male) or ≥90 to <100 mL/m2 (female)],4 may need updating based on contemporary steady state free precession cine normal ranges, for example, as provided in a recent European Association of Cardiovascular Imaging expert consensus document, to avoid being too sensitive or lacking specificity.5 Conflict of interest: none declared.