title: Diagnostic value of isoproterenol testing in arrhythmogenic right ventricular cardiomyopathy.
abstract: BACKGROUND
  Although the Task Force Criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) have recently been updated, the diagnosis remains challenging in the early stages. The aim of this study was to evaluate the diagnostic value of β-adrenergic stimulation in ARVC.
  
  
  RESULTS
  We evaluated 412 consecutive patients (213 men, age 41.5±16 years) referred for premature ventricular contractions evaluation or suspected ARVC. Isoproterenol testing was performed with continuous infusion of isoproterenol (45 μg/min) for 3 minutes. It was considered positive if there were either (1) polymorphic premature ventricular contractions with ≥1 couplet or (2) sustained or nonsustained ventricular tachycardia with left bundle branch block excluding right ventricular outflow tract ventricular tachycardia. ARVC was diagnosed in 35 patients at initial evaluation (23 men, aged 42±15 years). Isoproterenol testing was positive in 32 of 35 (91.4%) patients with ARVC and in 42 of 377 (11.1%) patients without ARVC (P<0.0001). Sensitivity, specificity, positive, and negative predictive values of isoproterenol testing to diagnose ARVC were 91.4%, 88.9%, 43.2%, and 99.1%, respectively. During a mean follow-up period of 5.6±4.4 years, 6 additional patients met diagnostic criteria for ARVC. Importantly, initial isoproterenol testing was positive in 6 of 6 (100%) of these patients. Survival free from ARVC diagnosis was significantly lower in the positive isoproterenol group than in the negative isoproterenol group (P<0.0001, exact log-rank test).
  
  
  CONCLUSIONS
  Ventricular arrhythmogenicity during isoproterenol testing is highly sensitive (sensitivity, 91.4%) for the diagnosis of ARVC, particularly in its early stages.
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France. arnaud.denis@chu-bordeaux.fr.
authors: Arnaud
authors: A
authors: Denis
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Frédéric
authors: F
authors: Sacher
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Nicolas
authors: N
authors: Derval
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Han S
authors: HS
authors: Lim
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Hubert
authors: H
authors: Cochet
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Ashok J
authors: AJ
authors: Shah
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Matthew
authors: M
authors: Daly
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Xavier
authors: X
authors: Pillois
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Khaled
authors: K
authors: Ramoul
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Yuki
authors: Y
authors: Komatsu
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Adlane
authors: A
authors: Zemmoura
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Sana
authors: S
authors: Amraoui
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Philippe
authors: P
authors: Ritter
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Sylvain
authors: S
authors: Ploux
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Pierre
authors: P
authors: Bordachar
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Mélèze
authors: M
authors: Hocini
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Pierre
authors: P
authors: Jaïs
authors: From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université Victor Segalen, Bordeaux II, LIRYC Institute, Bordeaux, France.
authors: Michel
authors: M
authors: Haïssaguerre
mesh_terms: D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis* / Q000503:physiopathology; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D007263:Infusions, Parenteral; D007545:Isoproterenol / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018879:Ventricular Premature Complexes / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D000318:Adrenergic beta-Agonists; D007545:Isoproterenol
keywords: arrhythmogenic right ventricular dysplasia; diagnosis; isoproterenol; tachycardia, ventricular