Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Circ Arrhythm Electrophysiol. 2010 Dec;3(6):632-8. doi: 10.1161/CIRCEP.110.958116. Epub 2010 Oct 11.
The diagnostic reliability and pathophysiologic relevance of different noninvasive diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are undefined. We tested the association between noninvasive diagnostic criteria for ARVC and the presence of low-voltage areas (LVAs) detected at electroanatomic voltage mapping (EAM).
Noninvasive diagnostic criteria, including ECG, signal-averaged ECG (SAECG), and cardiac magnetic resonance (CMR) criteria, were compared with the presence and location of LVAs detected at right ventricular (RV) EAM in 17 patients (9 men) aged 50 ± 16 years with biopsy specimen-proven ARVC. LVAs were found in 15 (88%) patients. Patients with surface ECG abnormalities showed a higher degree of RV involvement than those without ECG abnormalities (number of LVAs, 1.8 ± 0.5 versus 0.9 ± 0.6, respectively; P < 0.01). A significant association was found between SAECG abnormalities and LVAs in the RV outflow tract (P = 0.03) but not between SAECG parameters and LVAs in other RV regions. Among CMR findings, RV delayed enhancement was more significantly associated with the distribution of LVAs (free wall, P < 0.01; outflow tract, P < 0.01; posteroinferior wall, P = 0.02). Regional RV dysfunction also showed a good correlation with LVAs, with the most significant association being found with the free wall (P = 0.01), whereas RV fat infiltration at CMR was not correlated with LVAs.
In patients with ARVC, SAECG abnormalities correlate with the presence of LVAs selectively in the RV outflow tract, whereas surface ECG abnormalities are associated with a more diffuse RV involvement. Myocardial delayed enhancement is the CMR finding more strongly associated with LVAs, thus supporting the appropriateness of its inclusion among diagnostic criteria for ARVC.
心律失常性右室心肌病（ARVC）不同无创诊断标准的诊断可靠性和病理生理学相关性尚未明确。我们检测了 ARVC 的无创诊断标准与电解剖电压标测（EAM）检测到的低电压区（LVA）的存在之间的相关性。
我们比较了 17 例（9 名男性）年龄 50±16 岁、经活检证实的 ARVC 患者的 EAM 右心室（RV）检测到的 LVA 的存在和位置与心电图（ECG）、信号平均心电图（SAECG）和心脏磁共振（CMR）标准之间的关系。15 例（88%）患者存在 LVA。有体表心电图异常的患者 RV 受累程度高于无心电图异常的患者（LVA 数分别为 1.8±0.5 与 0.9±0.6；P<0.01）。SAECG 异常与 RV 流出道 LVA 之间存在显著相关性（P=0.03），但 SAECG 参数与 RV 其他区域的 LVA 之间无相关性。CMR 发现中，RV 延迟强化与 LVA 的分布相关性更显著（游离壁，P<0.01；流出道，P<0.01；后下壁，P=0.02）。区域性 RV 功能障碍与 LVA 也具有良好的相关性，与游离壁的相关性最显著（P=0.01），而 CMR 显示的 RV 脂肪浸润与 LVA 无相关性。
在 ARVC 患者中，SAECG 异常与 RV 流出道的 LVA 存在选择性相关，而体表心电图异常与更弥漫性的 RV 受累相关。心肌延迟强化是与 LVA 相关性最强的 CMR 发现，因此支持其作为 ARVC 诊断标准之一的适当性。
