Reasearch Awards nomination

Email updates

Keep up to date with the latest news and content from Journal of Cardiovascular MR and BioMed Central.

Open Access Highly Accessed Research

Arrhythmogenic right ventricular cardiomyopathy mimics: role of cardiovascular magnetic resonance

Giovanni Quarta1, Syed I Husain1, Andrew S Flett1, Daniel M Sado12, Charles Y Chao1, Marıá T Tomé Esteban1, William J McKenna12, Antonios Pantazis1 and James C Moon12*

Author Affiliations

1 The Heart Hospital, University College London Hospitals Trust, London, UK

2 The Institute of Cardiovascular Science, University College London, London, UK

For all author emails, please log on.

Journal of Cardiovascular Magnetic Resonance 2013, 15:16  doi:10.1186/1532-429X-15-16

Published: 11 February 2013

Abstract

Background

Cardiovascular magnetic resonance (CMR) is commonly used in patients with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC) based on ECG, echocardiogram and Holter. However, various diseases may present with clinical characteristics resembling ARVC causing diagnostic dilemmas. The aim of this study was to explore the role of CMR in the differential diagnosis of patients with suspected ARVC.

Methods

657 CMR referrals suspicious for ARVC in a single tertiary referral centre were analysed. Standardized CMR imaging protocols for ARVC were performed. Potential ARVC mimics were grouped into: 1) displacement of the heart, 2) right ventricular overload, and 3) non ARVC-like cardiac scarring. For each, a judgment of clinical impact was made.

Results

Twenty patients (3.0%) fulfilled imaging ARVC criteria. Thirty (4.6%) had a potential ARVC mimic, of which 25 (3.8%) were considered clinically important: cardiac displacement (n=17), RV overload (n=7) and non-ARVC like myocardial scarring (n=4). One patient had two mimics; one patient had dual pathology with important mimic and ARVC. RV overload and scarring conditions were always thought clinically important whilst the importance of cardiac displacement depended on the degree of displacement from severe (partial absence of pericardium) to epiphenomenon (minor kyphoscoliosis).

Conclusions

Some patients referred for CMR with suspected ARVC fulfil ARVC imaging criteria (3%) but more have otherwise unrecognised diseases (4.6%) mimicking potentially ARVC. Clinical assessment should reflect this, emphasising the assessment and/or exclusion of potential mimics in parallel with the detection of ARVC major and minor criteria.

Keywords:
Cardiovascular magnetic resonance; Arrhythmogenic right ventricular cardiomyopathy; Differential diagnosis; Mimics