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Right Ventricular Strain and Dyssynchrony Assessment in Arrhythmogenic Right Ventricular Cardiomyopathy: A Cardiac Magnetic Resonance Feature-Tracking Study
Abstracts
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573 Reproducibility of Cardiac Magnetic Resonance Imaging (CMR)-Derived Right Ventricular Parameters in Repaired Tetralogy of Fallot (ToF) G. Gnanappa 1,2,∗ , I. Rashid 2,5 , D. Celermajer 3,4 , J. Ayer 1,4 , R. Puranik 1,2,3,4 1 The Children’s Hospital at Westmead, Sydney, Australia 2 Cardiovascular Magnetic Resonance, Sydney, Australia 3 Royal Prince Alfred Hospital, Sydney, Australia 4 The University of Sydney, Australia 5 Victor Chang Cardiac Research Institute, Sydney, Australia
Background: Quantification of RV volumes is problematic owing to variable reproducibility. CMR has the ability to more comprehensively survey the entire RV, including the RVOT, which commonly contributes to RV dilatation in ToF and is often less well seen on echocardiography. Aims: We aimed to determine the inter-observer reproducibility of CMR-derived RV volumes generated by two independent and experienced (SCMR Level III) observers in ToF patients with varying degrees of RV dilatation. Methods: We performed a retrospective analysis of 120 consecutive patients with repaired ToF who underwent CMR. Two blinded observers calculated RV volumes in each oblique short axis slice independently. Bland-Altman analysis and inter-observer correlation coefficients (ICC) were assessed. Results: Patients were either: 1) mild-moderate RV dilatation with indexed RV end-diastolic volume RVEDVi<150ml/m2 (n=71, 50%male, mean age 24±10 years); or 2) severe RV dilatation with RVEDVi>150ml/m2 (n=49, 59%male, mean age 27±12 years). Between observers the mean RVEDVi difference in group 1 was 1.8±3.9ml/m2 (95% limit of agreement -5.7 to 9.4, ICC 0.97). For group 2, the RVEDVi mean difference was 3.4±6.1ml/m2 (95% limit of agreement -8.6 to 15.4, ICC 0.98). Good agreement was also observed for indexed RV end-systolic volume (2.5±5.7, 95% limit of agreement -8.6 to 13.65, ICC 0.98) and RV ejection fraction (-0.7±2.3, 95% limit of agreement -5.3 to 3.9, ICC 0.97). Conclusions: In patients with repaired ToF and variable degrees of RV dilatation, CMR assessment of RV volumes and function has high inter-observer reproducibility. This has implications for decisions about the timing of pulmonary valve replacement. http://dx.doi.org/10.1016/j.hlc.2016.06.575
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574 Right Ventricular Strain and Dyssynchrony Assessment in Arrhythmogenic Right Ventricular Cardiomyopathy: A Cardiac Magnetic Resonance Feature-Tracking Study G. Nucifora 1,∗ , G. Prati 2 , G. Vitrella 2 , G. Allocca 3 , S. Cukon Buttignoni 3 , D. Muser 4 , G. Morocutti 4 , B. Pinamonti 2 , G. Sinagra 2 , J. Selvanayagam 1,5,6 , A. Proclemer 4 1 South
Australian Health & Medical Research Institute, Adelaide, Australia 2 University Hospital Riuniti, Trieste, Italy 3 Conegliano General Hospital, Conegliano, Italy 4 University Hospital Santa Maria della Misericordia, Udine, Italy 5 Flinders Medical Centre, Adelaide, Australia 6 Flinders University, Adelaide, Australia Aim: Analysis of regional dysfunction by cardiac magnetic resonance (CMR) imaging in arrhythmogenic right ventricular cardiomyopathy (ARVC) may be inadequate due to the complex contraction pattern of the RV. Aim of the present study was to determine the utility of right ventricular (RV) strain and dyssynchrony assessment in ARVC using featuretracking CMR analysis. Methods: Thirty-two consecutive patients with ARVC referred to CMR imaging were included. Thirty-two patients with idiopathic right ventricular outflow tract arrhythmias (RVOT-A) and 32 control subjects, matched for age and gender to the ARVC group, were included for comparison purpose. CMR imaging was performed to assess biventricular function; feature-tracking analysis was applied to the cine CMR images to assess regional and global longitudinal, circumferential and radial strain (GLS, GCS, GRS) and RV dyssynchrony (defined as the standard deviation of the time-to-peak strain of the RV segments; SD-TPS). Results: GLS (-17±5% vs.-26±6% vs.-29±6%; p<0.001), GCS (-9±4% vs. -12±4% vs. -13±5%; p=0.001) and GRS (18 [12-26]% vs. 22[15-32]% vs. 27[20-39]%; p=0.015) were significantly lower and SD-TPS in all three directions were significantly higher among ARVC patients compared to RVOT-A patients and controls. RV GLS>-23.19%, longitudinal SD-TPS>113.13ms and circumferential SD-TPS>177.11ms allowed correct identification of 88%, 75% and 63% of ARVC patients with no or only minor CMR criteria for ARVC diagnosis. Conclusions: Strain analysis by feature-tracking CMR helps to objectively quantify global and regional RV dysfunction and RV dyssynchrony in ARVC patients and provides incremental value over conventional CMR imaging. http://dx.doi.org/10.1016/j.hlc.2016.06.576
S248
573 Reproducibility of Cardiac Magnetic Resonance Imaging (CMR)-Derived Right Ventricular Parameters in Repaired Tetralogy of Fallot (ToF) G. Gnanappa 1,2,∗ , I. Rashid 2,5 , D. Celermajer 3,4 , J. Ayer 1,4 , R. Puranik 1,2,3,4 1 The Children’s Hospital at Westmead, Sydney, Australia 2 Cardiovascular Magnetic Resonance, Sydney, Australia 3 Royal Prince Alfred Hospital, Sydney, Australia 4 The University of Sydney, Australia 5 Victor Chang Cardiac Research Institute, Sydney, Australia
Background: Quantification of RV volumes is problematic owing to variable reproducibility. CMR has the ability to more comprehensively survey the entire RV, including the RVOT, which commonly contributes to RV dilatation in ToF and is often less well seen on echocardiography. Aims: We aimed to determine the inter-observer reproducibility of CMR-derived RV volumes generated by two independent and experienced (SCMR Level III) observers in ToF patients with varying degrees of RV dilatation. Methods: We performed a retrospective analysis of 120 consecutive patients with repaired ToF who underwent CMR. Two blinded observers calculated RV volumes in each oblique short axis slice independently. Bland-Altman analysis and inter-observer correlation coefficients (ICC) were assessed. Results: Patients were either: 1) mild-moderate RV dilatation with indexed RV end-diastolic volume RVEDVi<150ml/m2 (n=71, 50%male, mean age 24±10 years); or 2) severe RV dilatation with RVEDVi>150ml/m2 (n=49, 59%male, mean age 27±12 years). Between observers the mean RVEDVi difference in group 1 was 1.8±3.9ml/m2 (95% limit of agreement -5.7 to 9.4, ICC 0.97). For group 2, the RVEDVi mean difference was 3.4±6.1ml/m2 (95% limit of agreement -8.6 to 15.4, ICC 0.98). Good agreement was also observed for indexed RV end-systolic volume (2.5±5.7, 95% limit of agreement -8.6 to 13.65, ICC 0.98) and RV ejection fraction (-0.7±2.3, 95% limit of agreement -5.3 to 3.9, ICC 0.97). Conclusions: In patients with repaired ToF and variable degrees of RV dilatation, CMR assessment of RV volumes and function has high inter-observer reproducibility. This has implications for decisions about the timing of pulmonary valve replacement. http://dx.doi.org/10.1016/j.hlc.2016.06.575
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574 Right Ventricular Strain and Dyssynchrony Assessment in Arrhythmogenic Right Ventricular Cardiomyopathy: A Cardiac Magnetic Resonance Feature-Tracking Study G. Nucifora 1,∗ , G. Prati 2 , G. Vitrella 2 , G. Allocca 3 , S. Cukon Buttignoni 3 , D. Muser 4 , G. Morocutti 4 , B. Pinamonti 2 , G. Sinagra 2 , J. Selvanayagam 1,5,6 , A. Proclemer 4 1 South
Australian Health & Medical Research Institute, Adelaide, Australia 2 University Hospital Riuniti, Trieste, Italy 3 Conegliano General Hospital, Conegliano, Italy 4 University Hospital Santa Maria della Misericordia, Udine, Italy 5 Flinders Medical Centre, Adelaide, Australia 6 Flinders University, Adelaide, Australia Aim: Analysis of regional dysfunction by cardiac magnetic resonance (CMR) imaging in arrhythmogenic right ventricular cardiomyopathy (ARVC) may be inadequate due to the complex contraction pattern of the RV. Aim of the present study was to determine the utility of right ventricular (RV) strain and dyssynchrony assessment in ARVC using featuretracking CMR analysis. Methods: Thirty-two consecutive patients with ARVC referred to CMR imaging were included. Thirty-two patients with idiopathic right ventricular outflow tract arrhythmias (RVOT-A) and 32 control subjects, matched for age and gender to the ARVC group, were included for comparison purpose. CMR imaging was performed to assess biventricular function; feature-tracking analysis was applied to the cine CMR images to assess regional and global longitudinal, circumferential and radial strain (GLS, GCS, GRS) and RV dyssynchrony (defined as the standard deviation of the time-to-peak strain of the RV segments; SD-TPS). Results: GLS (-17±5% vs.-26±6% vs.-29±6%; p<0.001), GCS (-9±4% vs. -12±4% vs. -13±5%; p=0.001) and GRS (18 [12-26]% vs. 22[15-32]% vs. 27[20-39]%; p=0.015) were significantly lower and SD-TPS in all three directions were significantly higher among ARVC patients compared to RVOT-A patients and controls. RV GLS>-23.19%, longitudinal SD-TPS>113.13ms and circumferential SD-TPS>177.11ms allowed correct identification of 88%, 75% and 63% of ARVC patients with no or only minor CMR criteria for ARVC diagnosis. Conclusions: Strain analysis by feature-tracking CMR helps to objectively quantify global and regional RV dysfunction and RV dyssynchrony in ARVC patients and provides incremental value over conventional CMR imaging. http://dx.doi.org/10.1016/j.hlc.2016.06.576