Key result
Left ventricular involvement was present in 52.4% of ARVC patients, strongly correlated with severe right ventricular abnormalities, and had a similar long-term cardiac prognosis to isolated ARVC.
Why the study?
Does left ventricular involvement in ARVC affect long-term cardiac prognosis compared to isolated ARVC?
Cohort (n=21)
Does left ventricular involvement in ARVC affect long-term cardiac prognosis compared to isolated ARVC?
Left ventricular involvement is common in ARVC and correlates with severe right ventricular abnormalities, but does not appear to significantly alter long-term cardiac prognosis.
LV involvement does not worsen ARVC prognosis; leaves open whether phenotype-specific imaging refines risk models in prospective cohorts.
Aim: To report frequency, severity and prognosis of left ventricular (LV) involvement using cardiac magnetic resonance (CMR) in patients diagnosed with arrhythmogenic right ventricular cardiomyopathy (ARVC). Methods: We retrospectively evaluated the CMR of 202 patients referred for suspicion of ARVC on the basis of the presence of major and minor criteria of the revised task force criteria 2010, between 2008 and 2012. In this study LV involvement was considered present in subjects with one or more of the following criteria in CMR: LVEDV above limit of normal, LV ejection fraction (LVEF) <55%, LV late gadolinium enhancement (LVLE) with non ischemic pattern, and/or LV wall motion abnormalities (WMAs). Follow up for the occurrence of cardiac death, ventricular tachycardia/ fibrillation (TV/FV) or, automated implantable defibrillator was obtained at a mean of 31 ± 20.6 months. Results: 21 patients (9 men and 12 women) were diagnosed ARVC, aged 47 ± 15 years. LV-ARVC was found in 10 patients (52.4%). No difference was found between ARVC and LV-ARVC in demographic, clinical neither ECG anomalies except for LBBB-TV morphology in ARVC (p = 0.02). Marked right ventricle (RV) regional aneurysm as assessed by echocardiography was significantly correlated with LV-WMAs and LVEF dysfunction (r = 0.9, p = 0.0001; r = 0.89, p = 0.0001). In CMR, severe regional WMAs of RV and RVEF dysfunction are strongly correlated with LV-WMAs (r = 0.7, p = 0.01; r = 0.8, p = 0.02 respectively). RVLE correlated with LV-WMs and LVLE (r = 0.7, p = 0.03; r = 0.8,p = 0.01). LVLE was strongly correlated with LV-WMAs, LVEF and LVEDV (r = 0.9,p = 0.001; r = 0.8,p = 0.001; r = 0.8,p = 0.001). At long term follow up the cardiac prognosis of LV-ARVC was similar to ARVC. Conclusion: Left ventricular involvement in ARVC is common and frequently associated with severe right ventricular abnormalities. The prognosis is similar with or without LV involvement. CMR is a good tool for the diagnosis and follow up of this cardiomyopathy.
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Ghannudi et al. (2013) conducted a cohort in Arrhythmogenic right ventricular cardiomyopathy (ARVC) (n=21). Left ventricular involvement vs. ARVC without left ventricular involvement was evaluated on Cardiac death, ventricular tachycardia/fibrillation, or automated implantable defibrillator. Left ventricular involvement was present in 52.4% of ARVC patients, strongly correlated with severe right ventricular abnormalities, and had a similar long-term cardiac prognosis to isolated ARVC.
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