Re-evaluation of 89 patients previously diagnosed with ARVD/C showed that only 27% met Task Force criteria, with misdiagnosis largely driven by over-reliance on qualitative MRI findings.
Observational (n=89)
No
Does comprehensive re-evaluation using International Task Force criteria alter the diagnosis in patients previously diagnosed with ARVD/C?
A significant proportion of patients diagnosed with ARVD/C are misdiagnosed due to over-reliance on qualitative MRI findings, emphasizing the need for comprehensive evaluation using Task Force criteria.
INTRODUCTION: Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) has major implications for the management of patients and their first-degree relatives. Diagnosis is based on a set of criteria proposed by the International Task Force for Cardiomyopathies. We report our experience in providing a re-evaluation for patients who previously have been diagnosed with ARVD/C. METHODS AND RESULTS: We studied 89 patients who requested a re-evaluation for diagnosis of ARVD/C at our center. Each of these patients had been diagnosed with ARVD/C at their initial evaluation. Each patient was re-evaluated with clinical history, physical examination, and noninvasive testing at our center. Invasive testing, which included electrophysiologic testing, right ventricular angiography, and endomyocardial biopsy, was performed when clinically indicated. Sixty (92%) of the 65 patients who had undergone magnetic resonance imaging (MRI) at an outside institution were reported to have an abnormal MRI consistent with ARVD/C. Among these patients, the only abnormality identified was the qualitative finding of intramyocardial fat/wall thinning in 46 patients. On re-evaluation, these qualitative findings were not confirmed. None of these 46 patients ultimately were diagnosed with ARVD/C. Among the entire patient group, only 24 (27%) of the 89 patients met the Task Force criteria for ARVD/C. CONCLUSION: This study demonstrates that the high frequency of "misdiagnosis" of ARVD/C is due to over-reliance on the presence of intramyocardial fat/wall thinning on MRI, incomplete diagnostic testing, and lack of awareness of the Task Force criteria. Diagnosis of ARVD/C cannot rely solely upon qualitative features on MRI.
Bomma et al. (2004) conducted an observational in Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) (n=89). Clinical re-evaluation using Task Force criteria vs. Initial outside diagnosis was evaluated on Confirmed diagnosis of ARVD/C meeting Task Force criteria. Re-evaluation of 89 patients previously diagnosed with ARVD/C showed that only 27% met Task Force criteria, with misdiagnosis largely driven by over-reliance on qualitative MRI findings.