Cardiac magnetic resonance in mutation-positive ARVD/C revealed a characteristic disease pattern involving the basal inferior (94%) and anterior RV (87%), and the posterolateral LV (80%).
Observational (n=74)
Mutation-positive ARVD/C exhibits a characteristic pattern involving the basal inferior and anterior RV, and posterolateral LV, displacing the RV apex from the traditional Triangle of Dysplasia.
INTRODUCTION: The traditional description of the Triangle of Dysplasia in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) predates genetic testing and excludes biventricular phenotypes. METHODS AND RESULTS: We analyzed Cardiac Magnetic Resonance (CMR) studies of 74 mutation-positive ARVD/C patients for regional abnormalities on a 5-segment RV and 17-segment LV model. The location of electroanatomic endo- and epicardial scar and site of successful VT ablation was recorded in 11 ARVD/C subjects. Among 54/74 (73%) subjects with abnormal CMR, the RV was abnormal in almost all (96%), and 52% had biventricular involvement. Isolated LV abnormalities were uncommon (4%). Dyskinetic basal inferior wall (94%) was the most prevalent RV abnormality, followed by basal anterior wall (87%) dyskinesis. Subepicardial fat infiltration in the posterolateral LV (80%) was the most frequent LV abnormality. Similar to CMR data, voltage maps revealed scar (<0.5 mV) in the RV basal inferior wall (100%), followed by the RV basal anterior wall (64%) and LV posterolateral wall (45%). All 16 RV VTs originated from the basal inferior wall (50%) or basal anterior wall (50%). Of 3 LV VTs, 2 localized to the posterolateral wall. In both modalities, RV apical involvement never occurred in isolation. CONCLUSION: Mutation-positive ARVD/C exhibits a previously unrecognized characteristic pattern of disease involving the basal inferior and anterior RV, and the posterolateral LV. The RV apex is only involved in advanced ARVD/C, typically as a part of global RV involvement. These results displace the RV apex from the Triangle of Dysplasia, and provide insights into the pathophysiology of ARVD/C.
Riele et al. (Wed,) conducted a observational in Mutation-positive Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (n=74). Cardiac Magnetic Resonance (CMR) and electroanatomic mapping was evaluated on Regional abnormalities on CMR. Cardiac magnetic resonance in mutation-positive ARVD/C revealed a characteristic disease pattern involving the basal inferior (94%) and anterior RV (87%), and the posterolateral LV (80%).