Retrospective Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2014; 6(7): 675-681
Published online Jul 26, 2014. doi: 10.4330/wjc.v6.i7.675
Is cardiac MRI an effective test for arrhythmogenic right ventricular cardiomyopathy diagnosis?
Santhi Chellamuthu, Alyson M Smith, Steven M Thomas, Catherine Hill, Peter W G Brown, Abdallah Al-Mohammad
Santhi Chellamuthu, Steven M Thomas, Catherine Hill, Peter W G Brown, Department of Radiology, Sheffield Teaching Hospitals NHS trust, Northern General Hospital, Sheffield S5 7AU, United Kingdom
Alyson M Smith, Abdallah Al-Mohammad, Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield S5 7AU, United Kingdom
Author contributions: Chellamuthu S and Smith AM contributed to the acquisition, analysis and interpretation of data, drafting and revision of the article; Thomas SM, Hill C, Brown PWG and Al-Mohammad A contributed to the conception and design of the study, revision of the article for important intellectual content; all authors approved the final version to be published.
Correspondence to: Dr. Alyson M Smith, Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, United Kingdom. smith_alyson@hotmail.com
Telephone: +44-11-42434343 Fax: +44-11-42434343
Received: April 1, 2014
Revised: May 28, 2014
Accepted: June 27, 2014
Published online: July 26, 2014
Processing time: 141 Days and 3.1 Hours
Abstract

AIM: To evaluate the referrals with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC) and compare cardiac MR (cMR) findings against clinical diagnosis.

METHODS: A retrospective analysis of 114 (age range 16 to 83, males 55% and females 45%) patients referred for cMR with a suspected diagnosis of ARVC between May 2006 and February 2010 was performed after obtaining institutional approval for service evaluation. Reasons for referral including clinical symptoms and family history of sudden death, electrocardiogram and echo abnormalities, cMR findings, final clinical diagnosis and information about clinical management were obtained. The results of cMR were classified as major, minor, non-specific or negative depending on both functional and tissue characterisation and the cMR results were compared against the final clinical diagnosis.

RESULTS: The most common reasons for referral included arrhythmias (30%) and a family history of sudden death (20%). Of the total cohort of 114 patients: 4 patients (4%) had major cMR findings for ARVC, 13 patients (11%) had minor cMR findings, 2 patients had non-specific cMR findings relating to the right ventricle and 95 patients had a negative cMR. Of the 4 patients who had major cMR findings, 3 (75%) had a positive clinical diagnosis. In contrast, of the 13 patients who had minor cMR findings, only 2 (15%) had a positive clinical diagnosis. Out of the 95 negative patients, clinical details were available for 81 patients and none of them had ARVC. Excluding the 14 patients with no clinical data and final diagnosis, the sensitivity of the test was 100%, specificity 87%, positive predictive value 29% and the negative predictive value 100%.

CONCLUSION: CMR is a useful tool for ARVC evaluation because of the high negative predictive value as the outcome has a significant impact on the clinical decision-making.

Keywords: Arrhythmogenic right ventricular cardiomyopathy; Cardiomyopathy; Right ventricular; Arrhythmias; Magnetic resonance imaging; Diagnosis; Implantable cardiac defibrillator

Core tip: This study was designed to evaluate the referrals with suspected Arrhythmogenic right ventricular cardiomyopathy (ARVC) and compare the findings of cardiac magnetic resonance imaging (cMR) against clinical diagnosis. Currently the diagnosis depends upon a combination of variety of factors including imaging findings. We evaluated all the referrals in our institution over a 4-year period and found a high sensitivity and specificity of cMR for ARVC diagnosis. We have concluded that cMR is a very useful tool for ARVC evaluation because of the very high negative predictive value as the outcome has a significant impact on the clinical decision-making.