June 17, 2014Open Access
View Full PaperThe diagnostic performance of imaging methods in ARVC using the 2010 Task Force criteria
Key Result
Echocardiography demonstrated low diagnostic performance compared to CMR for ARVC, with only 50% of CMR-positive patients fulfilling echocardiographic criteria (sensitivity 50%, specificity 70%).
Study Design
Type
Observational (n=102)
Multicenter
Yes
Structured PICO
Does echocardiography accurately identify structural changes in ARVC compared to CMR using the 2010 Task Force criteria?
P
Population
102 patients with definite arrhythmogenic right ventricular cardiomyopathy (ARVC) from the Nordic ARVC Registry who had undergone both echocardiography and cardiac magnetic resonance (CMR) imaging (median age 42 ± 16 years, 36% female, 78% probands).
I
Intervention
Echocardiography
C
Comparator
Cardiac magnetic resonance (CMR) imaging
O
Outcome
Agreement between echocardiographic and CMR imaging data for fulfilling ARVC 2010 Task Force criteria (diagnostic performance including sensitivity, specificity, PPV, NPV)surrogate
Echocardiography has low sensitivity (50%) compared to CMR for detecting structural changes in ARVC, suggesting that CMR should be the preferred imaging modality for diagnosis.
Abstract
AIMS: This study evaluates the agreement between echocardiographic and cardiac magnetic resonance (CMR) imaging data, and the impact a discrepancy between the two may have on the clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS AND RESULTS: From the Nordic ARVC Registry, 102 patients with definite ARVC who had undergone both echocardiography and CMR were included (median age 42 ± 16 years, 36% female, 78% probands). Patients were divided into two groups according to CMR-positive or -negative criteria, and the echocardiographic data were compared between the two. There were 72 CMR-positive patients. They had significantly larger RV dimensions and lower fractional area change on echocardiography compared with CMR-negative patients; parasternal long-axis right ventricular outflow tract (RVOT) 37 ± 7 vs. 32 ± 5 mm, parasternal short-axis RVOT 38 ± 7 vs. 32 ± 6 mm, fractional area shortening 31 ± 9 vs. 39 ± 9% (P < 0.003 for all). Only 36 (50%) of the CMR-positive patients fulfilled ARVC criteria by echocardiography, hence the diagnostic performance was low; sensitivity 50% and specificity 70%, positive predictive value 80% and negative predictive value 37%. Individuals with regional wall abnormalities on CMR were more likely to have ventricular arrhythmias (77 vs. 57%, P = 0.047). CONCLUSION: A significant proportion of patients with imaging-positive ARVC by CMR did not fulfil echocardiographic ARVC 2010 criteria. These findings confirm that echocardiographic evaluation of subtle structural changes in the right ventricle may be unreliable, and the diagnostic performance of CMR compared with echocardiography should be reflected in the guidelines.