Imaging of scar in patients with ventricular arrhythmias of right ventricular origin: Cardiac magnetic resonance versus electroanatomic mapping

Pasquale Santangeli, Christian Hamilton-Craig, Antonio Dello Russo, Maurizio Pieroni, Michela Casella, Gemma Pelargonio, Luigi Di Biase, Costantino Smaldone, Stefano Bartoletti, Maria L. Narducci, Claudio Tondo, Fulvio Bellocci, Andrea Natale

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1359-1366
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume22
Issue number12
DOIs
StatePublished - Dec 2011
Externally publishedYes

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Gadolinium
Cicatrix
Cardiac Arrhythmias
Magnetic Resonance Spectroscopy
Biopsy
Heart Diseases
Myocarditis
Patient Rights
ROC Curve
Sensitivity and Specificity

Keywords

  • cardiac magnetic resonance imaging
  • electroanatomic mapping
  • ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Imaging of scar in patients with ventricular arrhythmias of right ventricular origin : Cardiac magnetic resonance versus electroanatomic mapping. / Santangeli, Pasquale; Hamilton-Craig, Christian; Russo, Antonio Dello; Pieroni, Maurizio; Casella, Michela; Pelargonio, Gemma; Di Biase, Luigi; Smaldone, Costantino; Bartoletti, Stefano; Narducci, Maria L.; Tondo, Claudio; Bellocci, Fulvio; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 22, No. 12, 12.2011, p. 1359-1366.

Research output: Contribution to journalArticle

Santangeli, P, Hamilton-Craig, C, Russo, AD, Pieroni, M, Casella, M, Pelargonio, G, Di Biase, L, Smaldone, C, Bartoletti, S, Narducci, ML, Tondo, C, Bellocci, F & Natale, A 2011, 'Imaging of scar in patients with ventricular arrhythmias of right ventricular origin: Cardiac magnetic resonance versus electroanatomic mapping', Journal of Cardiovascular Electrophysiology, vol. 22, no. 12, pp. 1359-1366. https://doi.org/10.1111/j.1540-8167.2011.02127.x
Santangeli, Pasquale ; Hamilton-Craig, Christian ; Russo, Antonio Dello ; Pieroni, Maurizio ; Casella, Michela ; Pelargonio, Gemma ; Di Biase, Luigi ; Smaldone, Costantino ; Bartoletti, Stefano ; Narducci, Maria L. ; Tondo, Claudio ; Bellocci, Fulvio ; Natale, Andrea. / Imaging of scar in patients with ventricular arrhythmias of right ventricular origin : Cardiac magnetic resonance versus electroanatomic mapping. In: Journal of Cardiovascular Electrophysiology. 2011 ; Vol. 22, No. 12. pp. 1359-1366.
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abstract = "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.",
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T1 - Imaging of scar in patients with ventricular arrhythmias of right ventricular origin

T2 - Cardiac magnetic resonance versus electroanatomic mapping

AU - Santangeli, Pasquale

AU - Hamilton-Craig, Christian

AU - Russo, Antonio Dello

AU - Pieroni, Maurizio

AU - Casella, Michela

AU - Pelargonio, Gemma

AU - Di Biase, Luigi

AU - Smaldone, Costantino

AU - Bartoletti, Stefano

AU - Narducci, Maria L.

AU - Tondo, Claudio

AU - Bellocci, Fulvio

AU - Natale, Andrea

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N2 - 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.

AB - 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.

KW - cardiac magnetic resonance imaging

KW - electroanatomic mapping

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