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Biventricular myocardial strain analysis using cardiac magnetic resonance feature tracking (CMR-FT) in patients with distinct types of right ventricular diseases comparing arrhythmogenic right ventricular cardiomyopathy (ARVC), right ventricular outflow-tract tachycardia (RVOT-VT), and Brugada syndrome (BrS)

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Abstract

Objectives

As underlying heart diseases of right ventricular tachyarrhythmias, ARVC causes wall-motion abnormalities based on fibrofatty myocardial degeneration, while RVOT-VT and BrS are thought to lack phenotypic MR characteristics. To examine whether cardiac magnetic resonance (CMR) feature tracking (FT) in addition to ARVC objectively facilitates detection of myocardial functional impairments in RVOT-VT and BrS.

Methods

Cine MR datasets of four retrospectively enrolled, age-matched study groups [n = 65; 16 ARVC, 26 RVOT-VT, 9 BrS, 14 healthy volunteers (HV)] were independently assessed by two distinctly experienced investigators regarding myocardial function using CMR-FT. Global strain (%) and strainrate (s−1) in radial and longitudinal orientation were assessed at RVOT as well as for left (LV) and right (RV) ventricle at a basal, medial and apical section with the addition of a biventricular circumferential orientation.

Results

RV longitudinal and radial basal strain (%) in ARVC (− 12.9 ± 4.2; 11.4 ± 5.1) were significantly impaired compared to RVOT-VT (− 18.0 ± 2.5, p ≤ 0.005; 16.4 ± 5.2, p ≤ 0.05). Synergistically, RVOT endocardial radial strain (%) in ARVC (33.8 ± 22.7) was significantly lower (p ≤ 0.05) than in RVOT-VT (54.3 ± 14.5). For differentiation against BrS, RV basal and medial radial strain values (%) (13.3 ± 6.1; 11.8 ± 2.9) were significantly reduced when compared to HV (21.0 ± 6.9, p ≤ 0.05; 20.1 ± 6.6, p ≤ 0.005), even in case of a normal RV ejection fraction (EF) (> 45%; n = 6) (12.0 ± 2.7 vs. 20.1 ± 6.6, p ≤ 0.05).

Conclusions

CMR-FT facilitates relevant differentiation in patients with right ventricular tachyarrhythmias: between ARVC against RVOT-VT and HV as well as between BrS with even a preserved EF against HV.

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Abbreviations

ARVC:

Arrhythmogenic right ventricular cardiomyopathy

AUC:

Area under curve

BrS:

Brugada syndrome

CMR:

Cardiac magnetic resonance

DSC-2:

Desmocolin-2

DSG-2:

Desmoglein-2

EF:

Ejection fraction

FT:

Feature tracking

LV:

Left ventricle left ventricular

LVEDVI:

Left ventricular end diastolic volume index

LVEF:

Left ventricular ejection fraction

LVESVI:

Left ventricular end systolic volume index

PKP-2:

Plakophillin-2

ROC:

Receiver operating curve

RV:

Right ventricle/right ventricular

RVEDVI:

Right ventricular end diastolic volume index

RVEF:

Right ventricular ejection fraction

RVESVI:

Right ventricular end systolic volume index

RVOT:

Right ventricular outflow tract

RVOT-VT:

Right ventricular outflow tract tachycardia

SA:

Short axis

SCD:

Sudden cardiac death

SCN5A:

Ion channel mutation in Brugada syndrome

SD:

Standard deviation

TFS:

Task Force Score

WMA:

Wall-motion abnormalities

4 CH:

Four chamber

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Author notes

  1. E. Schulze-Bahr and C. Schülke are co-contributing senior authors.

Authors and Affiliations

  1. Center of Radiology, Neuroradiology and Nuclear Medicine, Clemens Hospital Muenster, Duesbergweg 124, 48153, Muenster, Germany

    Philipp Heermann

  2. Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany

    P. Sporns, W. Heindel & C. Schülke

  3. Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany

    M. Koopmann

  4. Division of Cardiology, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany

    M. Paul

  5. Institute for Genetics of Heart Diseases, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany

    H. Fritsch & E. Schulze-Bahr

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  1. Philipp Heermann
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Contributions

WH, ESB and PH initiated the study concept. PH is the corresponding author of the manuscript. PH and HF participated in the myocardial strain analysis. PH and CS participated in the statistical analysis and PH and CS drafted the manuscript. WH, ESB, MP, HF, MK and PS contributed valuable comments and formulations. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Philipp Heermann.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional Review Board approval was obtained. The current study obtained approval and consent from the local ethics committee (ethics commission of the medical association Westfalen-Lippe and the medical faculty of the Westfälische-Wilhelms-University (WWU) Muenster; reference number: 2013-632-f-N).

Informed consent

Written informed consent was obtained from all subjects (patients) prior to their inclusion in the study.

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Heermann, P., Fritsch, H., Koopmann, M. et al. Biventricular myocardial strain analysis using cardiac magnetic resonance feature tracking (CMR-FT) in patients with distinct types of right ventricular diseases comparing arrhythmogenic right ventricular cardiomyopathy (ARVC), right ventricular outflow-tract tachycardia (RVOT-VT), and Brugada syndrome (BrS). Clin Res Cardiol 108, 1147–1162 (2019). https://doi.org/10.1007/s00392-019-01450-w

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