Scientific Session 18 — SS18: Cardiac Imaging - MRIThursday, April 26, 2018
2814. Regional ventricular dysfunction in cardiac sarcoidosis and ARVD/C
Najmi Varzaneh F*, Aliyari Ghasebeh M, Riele A, Kamel I, Zimmerman S. Johns Hopkins Hospital, Baltimore, MD
Address correspondence to F. Najmi Varzaneh (email@example.com)
Objective: Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inheritable cardiomyopathy characterized by structural abnormalities mainly of the right ventricle (RV) associated with variable expression, ventricular arrhythmias and sudden death. Cardiac sarcoidosis (CS) is a common mimic of ARVD/C. The distinction between ARVD/C and CS is still challenging. The purpose of this study was to investigate the utility of left and right ventricular strain analysis by cardiac MRI (CMR) in distinguishing these two entities.
Materials and Methods: A total of 60 patients meeting 2010 ARVD/C Task Force Criteria and 20 patients meeting 2014 Heart Rhythm Cardiac Sarcoidosis Criteria were identified from a retrospective review of patients referred to CMR between Jan 2009–Dec 2011. Regional and global systolic strain analysis was performed on cine SSFP CMR images. Global and segmental right ventricular (RV) and left ventricular (LV) longitudinal strains were measured on four-chamber long axis views and circumferential strains on short-axis views. Global RV and LV volumetric and functional parameters were calculated on dedicated software. MRI patterns of late gadolinium enhancement (LGE) were evaluated by an expert radiologist in all cases of CS and 52 cases of ARVD with available LGE.
Overall 80 cases were studied. There were no significant differences in RVEF and LVEF between two groups (The mean of RVEF was 44.25 ± 9.86 in ARVD group vs 41 ± 14.7 in CS group (p = 0.85) and the mean of LVEF was 58.7 ± 8.6 in ARVD group vs 52.5 ± 13.3 in CS group (p = 0.104)). RVEDVI, RVESVI, and LVEDVI were significantly higher in patients with ARVD vs CS. Patients with CS had significantly worse LV systolic longitudinal strain (LS) both globally (–11.4 ± 6.8 vs –20.3 ± 8, p < 0.001) and in the basal septum (–9.2 ± 6.5 vs –17.7 ± 8.1, p < 0.001). In contrast, patients with ARVD trended to worse RV systolic LS both globally (–16.7 ± 5.1 vs –19.2 ± 7.5, p = 0.195) and in the basal free wall (–23.26 ± 6.7 vs –26.9 ± 11.8, p = 0.128); however, the difference was not significant. Similar differences between groups were seen for circumferential RV and LV systolic strain measures. LGE on MRI was noted in all cases of CS and 38% of ARVD group. In patients with CS, LGE was more common in segments with worse strain function including basal anteroseptal and inferoseptal.
Conclusion: Regional and global longitudinal LV strain patterns are different in patients with CS vs ARVD/C as assessed by feature tracking CMR strain analysis, however, global ventricular function was not significantly different in two groups. LGE most commonly involved the mid inferolateral and apical inferolateral walls in ARVD, however, it was affected more in basal anteroseptal and inferoseptal in CS.