title: Left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy - a cardiac magnetic resonance imaging study.
abstract: BACKGROUND
  Few studies evaluated left ventricular (LV) involvement in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). The aim of this study is to determine the frequency, clinical presentation, and pattern of LV involvement in ARVD/C (LV-ARVD/C).
  
  
  METHODS
  We retrospectively evaluated the cardiac magnetic resonance (CMR) in 202 patients referred between 2008 and 2012 to our institution, and we determined the presence or the absence of CMR criteria in the revised task force criteria 2010 for the diagnosis of ARVD/C. A total of 21 patients were diagnosed with ARVD/C according to the revised task force criteria 2010. All included patients had no previous history of myocarditis, acute coronary syndrome, or any other cardiac disease that could interfere with the interpretations of structural abnormalities. The LV involvement in ARVD/C was defined by the presence of one or more of the following criteria: LV end-diastolic volume (LVEDV; >95 mL/m(2)), LV ejection fraction (LVEF; <55%), LV late enhancement of gadolinium (LVLE) in a non-ischemic pattern, and LV wall motion abnormalities (WMAs). In the follow-up for the occurrence of cardiac death, ventricular tachycardia (VT) was obtained at a mean of 31 ± 20.6 months.
  
  
  RESULTS
  A total of 21 patients had ARVD/C. The median age was 48 (33-63) years. In all, 11 patients (52.4%) had LV-ARVD/C. The demographic characteristics of patients with or without LV were similar. There was a higher frequency of left bundle-branch block (LBBB) VT morphology in ARVD/C (P = 0.04). In CMR, regional WMAs of right ventricle (RV) and RV ejection fraction (RVEF; <45%) were strongly correlated with LV-WMAs (r = 0.72, P = 0.02, r = 0.75, P = 0.02, respectively). RV late enhancement of gadolinium (RVLE) was associated with LV-WMs and LVLE (r = 0.7, P = 0.03; r = 0.8, P = 0.006). LVLE was associated with LV-WMAs, LVEF, and LVEDV (r = 0.9, P = 0.001; r = 0.8, P = 0.001; r = 0.8, P = 0.01).
  
  
  CONCLUSIONS
  LV involvement in ARVD/C is common and frequently associated with moderate to severe right ventricular (RV) abnormalities. The impact of LV involvement in ARVD/C on the prognosis needs further investigations.
authors: Radiology Department, University Hospital of Strasbourg, Strasbourg, France. ; Nuclear Medicine Department, University Hospital of Strasbourg, Strasbourg, France.
authors: Soraya
authors: S
authors: El Ghannudi
authors: Cardiology Department, University Hospital of Strasbourg, Strasbourg, France.
authors: Anthony
authors: A
authors: Nghiem
authors: Radiology Department, University Hospital of Strasbourg, Strasbourg, France.
authors: Philippe
authors: P
authors: Germain
authors: Radiology Department, University Hospital of Strasbourg, Strasbourg, France.
authors: Mi-Young
authors: MY
authors: Jeung
authors: Radiology Department, University Hospital of Strasbourg, Strasbourg, France.
authors: Afshin
authors: A
authors: Gangi
authors: Radiology Department, University Hospital of Strasbourg, Strasbourg, France.
authors: Catherine
authors: C
authors: Roy
keywords: arrhythmogenic right ventricular dysplasia; cardiac magnetic resonance imaging; left ventricle; prognosis