title: Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy: comparison of 3D standard electroanatomical voltage mapping and contrast-enhanced cardiac magnetic resonance.
abstract: BACKGROUND
  The hallmark lesion of arrhythmogenic right ventricular cardiomyopathy (ARVC) is fibrofatty scar replacement. We compared endocardial voltage mapping (EVM) and contrast-enhanced cardiac magnetic resonance (CE-CMR) for imaging scar lesions in ARVC patients.
  
  
  RESULTS
  We studied 23 consecutive ARVC patients (16 males; mean age, 38±12 years) who underwent RV EVM and CE-CMR and 37 control subjects. In 21 (91%) of 23 ARVC patients, RV EVM was abnormal, with a total of 45 electroanatomical scars (EAS): 17 (38%) in the inferobasal region, 12 (26.6%) in the anterolateral region, 8 (17.7%) in the RV outflow tract (RVOT), and 8 (17.7%) in the apex. RV delayed contrast enhancement (DCE) was found in 9 (39%) of 23 patients, with a total of 23 RV DCE scars: 4 (17.4%) in the inferobasal region, 9 (39.1%) in the anterolateral region, 4 (17.4%) in the RVOT, and 6 (26.1%) in the apex. There was a mismatch in 24 RV scars, with 22 EAS not confirmed by DCE and 2 DCE scars (both in the RVOT) undetected by EVM. In 9 (75%) of 12 patients with abnormal RV EVM/normal RV DCE, ≥1 DCEs were identified in the left ventricle (LV). Overall, ventricular DCE was detected in 78% of patients. No control subjects showed either EAS or DCE.
  
  
  CONCLUSIONS
  EVM and CE-CMR allow identification of RV scar lesions in most ARVC patients. CE-CMR is less sensitive than EVM in identifying RV scar lesions. The high prevalence of LV DCE confirms the frequent biventricular involvement and indicates the diagnostic relevance of LV scar detection by CE-CMR.
authors.affiliation: Departments of Cardiac, Thoracic, and Vascular Sciences, Radiology, and Medical-Diagnostic Sciences and Special Therapies, University of Padua Medical School, Padua, Italy.
authors.forename: Martina Perazzolo
authors.initials: MP
authors.lastname: Marra
authors.forename: Loira
authors.initials: L
authors.lastname: Leoni
authors.forename: Barbara
authors.initials: B
authors.lastname: Bauce
authors.forename: Francesco
authors.initials: F
authors.lastname: Corbetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.forename: Federico
authors.initials: F
authors.lastname: Migliore
authors.forename: Maria
authors.initials: M
authors.lastname: Silvano
authors.forename: Ilaria
authors.initials: I
authors.lastname: Rigato
authors.forename: Francesco
authors.initials: F
authors.lastname: Tona
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Luisa
authors.initials: L
authors.lastname: Cacciavillani
authors.forename: Cristina
authors.initials: C
authors.lastname: Basso
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Buja
authors.forename: Gaetano
authors.initials: G
authors.lastname: Thiene
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Domenico
authors.initials: D
authors.lastname: Corrado
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results