Imaging of Scar in Patients with Ventricular Arrhythmias of Right Ventricular Origin: Cardiac Magnetic Resonance Versus Electroanatomic Mapping
Imaging of Scar in Patients with RV Origin Arrhythmias: CMR Versus EAM. Introduction: Assessment of late gadolinium enhancement (LGE) at cardiac magnetic resonance is often used to detect scar in patients with arrhythmias of right ventricular (RV) origin. Recently, electroanatomic mapping (EAM) has...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2011-12, Vol.22 (12), p.1359-1366 |
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| creator | SANTANGELI, PASQUALE HAMILTON-CRAIG, CHRISTIAN RUSSO, ANTONIO DELLO PIERONI, MAURIZIO CASELLA, MICHELA PELARGONIO, GEMMA BIASE, LUIGI DI SMALDONE, COSTANTINO BARTOLETTI, STEFANO NARDUCCI, MARIA L. TONDO, CLAUDIO BELLOCCI, FULVIO NATALE, ANDREA |
| description | Imaging of Scar in Patients with RV Origin Arrhythmias: CMR Versus EAM. Introduction: Assessment of late gadolinium enhancement (LGE) at cardiac magnetic resonance is often used to detect scar in patients with arrhythmias of right ventricular (RV) origin. Recently, electroanatomic mapping (EAM) has been shown to reliably detect scars corresponding to different cardiomyopathic substrates. We compared LGE with EAM for the detection of scar in patients with arrhythmias of RV origin.
Methods and Results: Thirty‐one patients with RV arrhythmias and biopsy‐proven structural heart disease (18 ARVC and 13 myocarditis), and 5 with idiopathic RV outflow tract arrhythmias underwent LGE analysis and EAM with scar validation through EAM‐guided endomyocardial biopsy. EAM scars were present in 23 (64%) patients (all with structural heart disease), whereas LGE was present only in 12 (33%). In 2 cases, EAM provided a false‐positive diagnosis of a small scar in the basal perivalvular area. LGE correctly diagnosed EAM scar in 48% of patients, resulting in high positive (92%) but low negative (50%) predictive values. The distribution of LGE was significantly associated with the distribution of EAM scars (P < 0.001 in the free wall, P = 0.003 in the outflow tract, and P = 0.023 in the posterior/inferior wall). Presence of LGE reflected a higher extension of EAM scars (34.4 ± 16.5% vs 7.9 ± 10.1% of the RV area, P < 0.001). At receiver operating characteristic (ROC) analysis, an extension of scar ≥20% of the RV area was the best cut‐off value to detect LGE (sensitivity 83%, specificity 92%). Of note, LGE missed 10 of 11 (91%) patients with EAM scars |
| doi_str_mv | 10.1111/j.1540-8167.2011.02127.x |
| format | Article |
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Methods and Results: Thirty‐one patients with RV arrhythmias and biopsy‐proven structural heart disease (18 ARVC and 13 myocarditis), and 5 with idiopathic RV outflow tract arrhythmias underwent LGE analysis and EAM with scar validation through EAM‐guided endomyocardial biopsy. EAM scars were present in 23 (64%) patients (all with structural heart disease), whereas LGE was present only in 12 (33%). In 2 cases, EAM provided a false‐positive diagnosis of a small scar in the basal perivalvular area. LGE correctly diagnosed EAM scar in 48% of patients, resulting in high positive (92%) but low negative (50%) predictive values. The distribution of LGE was significantly associated with the distribution of EAM scars (P < 0.001 in the free wall, P = 0.003 in the outflow tract, and P = 0.023 in the posterior/inferior wall). Presence of LGE reflected a higher extension of EAM scars (34.4 ± 16.5% vs 7.9 ± 10.1% of the RV area, P < 0.001). At receiver operating characteristic (ROC) analysis, an extension of scar ≥20% of the RV area was the best cut‐off value to detect LGE (sensitivity 83%, specificity 92%). Of note, LGE missed 10 of 11 (91%) patients with EAM scars <20% of RV area.
Conclusions: LGE is significantly less sensitive than EAM in identifying RV cardiomyopathic substrates. Absence of LGE does not rule out the presence of small scars, and EAM with biopsy should be considered to increase the diagnostic yield. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1359‐1366, December 2011)</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/j.1540-8167.2011.02127.x</identifier><identifier>PMID: 21736658</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Adult ; Arrhythmias, Cardiac - diagnosis ; Biopsy ; cardiac magnetic resonance imaging ; Cicatrix - diagnosis ; electroanatomic mapping ; Electrocardiography ; Electrophysiologic Techniques, Cardiac - methods ; Female ; Gadolinium ; Heart Ventricles - pathology ; Humans ; Magnetic Resonance Imaging - methods ; Male ; Middle Aged ; Myocardium - pathology ; ventricular arrhythmias</subject><ispartof>Journal of cardiovascular electrophysiology, 2011-12, Vol.22 (12), p.1359-1366</ispartof><rights>2011 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4067-68af0868a3cb982973849569ea2ee7a4f76a220daf9b49452cfc4d7c15d9ebca3</citedby><cites>FETCH-LOGICAL-c4067-68af0868a3cb982973849569ea2ee7a4f76a220daf9b49452cfc4d7c15d9ebca3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1540-8167.2011.02127.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1540-8167.2011.02127.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21736658$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SANTANGELI, PASQUALE</creatorcontrib><creatorcontrib>HAMILTON-CRAIG, CHRISTIAN</creatorcontrib><creatorcontrib>RUSSO, ANTONIO DELLO</creatorcontrib><creatorcontrib>PIERONI, MAURIZIO</creatorcontrib><creatorcontrib>CASELLA, MICHELA</creatorcontrib><creatorcontrib>PELARGONIO, GEMMA</creatorcontrib><creatorcontrib>BIASE, LUIGI DI</creatorcontrib><creatorcontrib>SMALDONE, COSTANTINO</creatorcontrib><creatorcontrib>BARTOLETTI, STEFANO</creatorcontrib><creatorcontrib>NARDUCCI, MARIA L.</creatorcontrib><creatorcontrib>TONDO, CLAUDIO</creatorcontrib><creatorcontrib>BELLOCCI, FULVIO</creatorcontrib><creatorcontrib>NATALE, ANDREA</creatorcontrib><title>Imaging of Scar in Patients with Ventricular Arrhythmias of Right Ventricular Origin: Cardiac Magnetic Resonance Versus Electroanatomic Mapping</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Imaging of Scar in Patients with RV Origin Arrhythmias: CMR Versus EAM. Introduction: Assessment of late gadolinium enhancement (LGE) at cardiac magnetic resonance is often used to detect scar in patients with arrhythmias of right ventricular (RV) origin. Recently, electroanatomic mapping (EAM) has been shown to reliably detect scars corresponding to different cardiomyopathic substrates. We compared LGE with EAM for the detection of scar in patients with arrhythmias of RV origin.
Methods and Results: Thirty‐one patients with RV arrhythmias and biopsy‐proven structural heart disease (18 ARVC and 13 myocarditis), and 5 with idiopathic RV outflow tract arrhythmias underwent LGE analysis and EAM with scar validation through EAM‐guided endomyocardial biopsy. EAM scars were present in 23 (64%) patients (all with structural heart disease), whereas LGE was present only in 12 (33%). In 2 cases, EAM provided a false‐positive diagnosis of a small scar in the basal perivalvular area. LGE correctly diagnosed EAM scar in 48% of patients, resulting in high positive (92%) but low negative (50%) predictive values. The distribution of LGE was significantly associated with the distribution of EAM scars (P < 0.001 in the free wall, P = 0.003 in the outflow tract, and P = 0.023 in the posterior/inferior wall). Presence of LGE reflected a higher extension of EAM scars (34.4 ± 16.5% vs 7.9 ± 10.1% of the RV area, P < 0.001). At receiver operating characteristic (ROC) analysis, an extension of scar ≥20% of the RV area was the best cut‐off value to detect LGE (sensitivity 83%, specificity 92%). Of note, LGE missed 10 of 11 (91%) patients with EAM scars <20% of RV area.
Conclusions: LGE is significantly less sensitive than EAM in identifying RV cardiomyopathic substrates. Absence of LGE does not rule out the presence of small scars, and EAM with biopsy should be considered to increase the diagnostic yield. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1359‐1366, December 2011)</description><subject>Adult</subject><subject>Arrhythmias, Cardiac - diagnosis</subject><subject>Biopsy</subject><subject>cardiac magnetic resonance imaging</subject><subject>Cicatrix - diagnosis</subject><subject>electroanatomic mapping</subject><subject>Electrocardiography</subject><subject>Electrophysiologic Techniques, Cardiac - methods</subject><subject>Female</subject><subject>Gadolinium</subject><subject>Heart Ventricles - pathology</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>ventricular arrhythmias</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkctuEzEUhkcIREvhFZB3rGbwZTy2kVhUUVpaFYpSLhIb68TjSRzmEmyPmjxFXxkPKZHY4YV9pPP9_7HOn2WI4IKk83ZTEF7iXJJKFBQTUmBKqCh2T7LTY-NpqnHJcyYFO8lehLDBmLAK8-fZCSWCVRWXp9nDVQcr16_Q0KA7Ax65Hn2G6GwfA7p3cY2-pdI7M7apee79eh_XnYMwCRZutY7_ALfeJbd3aAa-dmDQR1j1NjqDFjYMPfTGJtyHMaB5a030A_QQh85N5Hab_vEye9ZAG-yrx_cs-3ox_zL7kN_cXl7Nzm9yU-JK5JWEBst0M7NUkirBZKl4pSxQawWUjaiAUlxDo5alKjk1jSlrYQivlV0aYGfZm4Pv1g-_Rhui7lwwtm2ht8MYtCJCciEUTqQ8kMYPIXjb6K13Hfi9JlhPaeiNnpaup6XrKQ39Jw29S9LXj0PGZWfro_Dv-hPw_gDcu9bu_9tYX8_mU5X0-UHvQrS7ox78T10JJrj-_ulScyrIxeKH1HfsNy11qhU</recordid><startdate>201112</startdate><enddate>201112</enddate><creator>SANTANGELI, PASQUALE</creator><creator>HAMILTON-CRAIG, CHRISTIAN</creator><creator>RUSSO, ANTONIO DELLO</creator><creator>PIERONI, MAURIZIO</creator><creator>CASELLA, MICHELA</creator><creator>PELARGONIO, GEMMA</creator><creator>BIASE, LUIGI DI</creator><creator>SMALDONE, COSTANTINO</creator><creator>BARTOLETTI, STEFANO</creator><creator>NARDUCCI, MARIA L.</creator><creator>TONDO, CLAUDIO</creator><creator>BELLOCCI, FULVIO</creator><creator>NATALE, ANDREA</creator><general>Blackwell Publishing Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201112</creationdate><title>Imaging of Scar in Patients with Ventricular Arrhythmias of Right Ventricular Origin: Cardiac Magnetic Resonance Versus Electroanatomic Mapping</title><author>SANTANGELI, PASQUALE ; HAMILTON-CRAIG, CHRISTIAN ; RUSSO, ANTONIO DELLO ; PIERONI, MAURIZIO ; CASELLA, MICHELA ; PELARGONIO, GEMMA ; BIASE, LUIGI DI ; SMALDONE, COSTANTINO ; BARTOLETTI, STEFANO ; NARDUCCI, MARIA L. ; TONDO, CLAUDIO ; BELLOCCI, FULVIO ; NATALE, ANDREA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4067-68af0868a3cb982973849569ea2ee7a4f76a220daf9b49452cfc4d7c15d9ebca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Arrhythmias, Cardiac - diagnosis</topic><topic>Biopsy</topic><topic>cardiac magnetic resonance imaging</topic><topic>Cicatrix - diagnosis</topic><topic>electroanatomic mapping</topic><topic>Electrocardiography</topic><topic>Electrophysiologic Techniques, Cardiac - methods</topic><topic>Female</topic><topic>Gadolinium</topic><topic>Heart Ventricles - pathology</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardium - pathology</topic><topic>ventricular arrhythmias</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SANTANGELI, PASQUALE</creatorcontrib><creatorcontrib>HAMILTON-CRAIG, CHRISTIAN</creatorcontrib><creatorcontrib>RUSSO, ANTONIO DELLO</creatorcontrib><creatorcontrib>PIERONI, MAURIZIO</creatorcontrib><creatorcontrib>CASELLA, MICHELA</creatorcontrib><creatorcontrib>PELARGONIO, GEMMA</creatorcontrib><creatorcontrib>BIASE, LUIGI DI</creatorcontrib><creatorcontrib>SMALDONE, COSTANTINO</creatorcontrib><creatorcontrib>BARTOLETTI, STEFANO</creatorcontrib><creatorcontrib>NARDUCCI, MARIA L.</creatorcontrib><creatorcontrib>TONDO, CLAUDIO</creatorcontrib><creatorcontrib>BELLOCCI, FULVIO</creatorcontrib><creatorcontrib>NATALE, ANDREA</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SANTANGELI, PASQUALE</au><au>HAMILTON-CRAIG, CHRISTIAN</au><au>RUSSO, ANTONIO DELLO</au><au>PIERONI, MAURIZIO</au><au>CASELLA, MICHELA</au><au>PELARGONIO, GEMMA</au><au>BIASE, LUIGI DI</au><au>SMALDONE, COSTANTINO</au><au>BARTOLETTI, STEFANO</au><au>NARDUCCI, MARIA L.</au><au>TONDO, CLAUDIO</au><au>BELLOCCI, FULVIO</au><au>NATALE, ANDREA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Imaging of Scar in Patients with Ventricular Arrhythmias of Right Ventricular Origin: Cardiac Magnetic Resonance Versus Electroanatomic Mapping</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2011-12</date><risdate>2011</risdate><volume>22</volume><issue>12</issue><spage>1359</spage><epage>1366</epage><pages>1359-1366</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Imaging of Scar in Patients with RV Origin Arrhythmias: CMR Versus EAM. Introduction: Assessment of late gadolinium enhancement (LGE) at cardiac magnetic resonance is often used to detect scar in patients with arrhythmias of right ventricular (RV) origin. Recently, electroanatomic mapping (EAM) has been shown to reliably detect scars corresponding to different cardiomyopathic substrates. We compared LGE with EAM for the detection of scar in patients with arrhythmias of RV origin.
Methods and Results: Thirty‐one patients with RV arrhythmias and biopsy‐proven structural heart disease (18 ARVC and 13 myocarditis), and 5 with idiopathic RV outflow tract arrhythmias underwent LGE analysis and EAM with scar validation through EAM‐guided endomyocardial biopsy. EAM scars were present in 23 (64%) patients (all with structural heart disease), whereas LGE was present only in 12 (33%). In 2 cases, EAM provided a false‐positive diagnosis of a small scar in the basal perivalvular area. LGE correctly diagnosed EAM scar in 48% of patients, resulting in high positive (92%) but low negative (50%) predictive values. The distribution of LGE was significantly associated with the distribution of EAM scars (P < 0.001 in the free wall, P = 0.003 in the outflow tract, and P = 0.023 in the posterior/inferior wall). Presence of LGE reflected a higher extension of EAM scars (34.4 ± 16.5% vs 7.9 ± 10.1% of the RV area, P < 0.001). At receiver operating characteristic (ROC) analysis, an extension of scar ≥20% of the RV area was the best cut‐off value to detect LGE (sensitivity 83%, specificity 92%). Of note, LGE missed 10 of 11 (91%) patients with EAM scars <20% of RV area.
Conclusions: LGE is significantly less sensitive than EAM in identifying RV cardiomyopathic substrates. Absence of LGE does not rule out the presence of small scars, and EAM with biopsy should be considered to increase the diagnostic yield. (J Cardiovasc Electrophysiol, Vol. 22, pp. 1359‐1366, December 2011)</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>21736658</pmid><doi>10.1111/j.1540-8167.2011.02127.x</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Arrhythmias, Cardiac - diagnosis Biopsy cardiac magnetic resonance imaging Cicatrix - diagnosis electroanatomic mapping Electrocardiography Electrophysiologic Techniques, Cardiac - methods Female Gadolinium Heart Ventricles - pathology Humans Magnetic Resonance Imaging - methods Male Middle Aged Myocardium - pathology ventricular arrhythmias |
| title | Imaging of Scar in Patients with Ventricular Arrhythmias of Right Ventricular Origin: Cardiac Magnetic Resonance Versus Electroanatomic Mapping |
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