P310Differentiation between arrhythmogenic right ventricular cardiomyopathy and athlete's heart using cardiac magnetic resonance based derived parameters and strain analysis

Abstract

Abstract Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a major cause of sudden cardiac death in young athletes. However diagnosing ARVC in highly trained athletes may be complicated because of overlapping features such as elevated right ventricular (RV) end-diastolic volume index or T-wave inversion in precordial leads. The revised Task Force criteria contain no specific cut-off value for professional athletes. Additional CMR parameters and CMR deformation imaging may have an added diagnostic value in this special patient population. Our goal was to determine novel CMR parameters which can help to distinguish between ARVC and athlete's heart. CMR examination of ARVC patients with definite diagnosis based on the revised Task Force criteria (n=34; 41±13 y, 22 male) and healthy professional athletes (members of the Hungarian national water polo, canoing or rowing team performing minimum of 15 hours of training per week, n=34, 32±6 y, 22 male) was performed. We evaluated left and right ventricular end-systolic, end-diastolic (EDVi) and stroke volume index, ejection fraction (EF) and mass. We established derived parameters such as ejection fraction ratio (LVEF/RVEF) and end-diastolic volume ratio (LVEDV/RVEDV). Global and regional strain analysis for the right ventricle was performed using feature tracking technique. Area under the ROC curves (AUC) of conventional and derived CMR parameters and CMR based strain values were analysed. There was no significant difference between RVEDVi of ARVC patients and athletes (124±17 vs 142±47), RVEF was lower in ARVC patients compared to athletes (56±5 vs 41±14%; p<0.001). Significant differences were found between athletes and ARVC patients in LVEDV/RVEDV (0.96±0.08 vs 0.82±0.23), LVEF/RVEF (1.04±0.06 vs 1.41±0.56), global circumferential strain (−34.8±5.9 vs −25.2±12.2) and regional strain values such as midventricular RV strain (−31.5±10.2 vs −20.0±13.4) or midventricular RV strain rate (−1.37±0.56 vs −1.04±0.68), respectively. RVEF and LVEF/RVEF showed excellent (AUC of 0.9–1.0), RV global strain and RV midventricular strain values showed good diagnostic accuracy (AUC of 0.8–0.9), while RVEDVi showed poor diagnostic accuracy (AUC of 0.59). Consequently, in highly trained healthy athletes RVEDVi is in the range of major Task Force criteria, while CMR based derived parameters such as LVEDV/RVEDV or LVEF/RVEF and both global and regional RV strain parameters can be useful parameters in the differential diagnosis. Acknowledgement/Funding National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277), ÚNKP-18-3-IV New National Excellence Program of Human Capacities.