Progress in the Diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia by Cardiac Magnetic Resonance Imaging Using Feature Tracking

Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a condition which continues to pose diagnostic challenges for noninvasive imaging. The 2010 ARVC/D Task Force criteria was a major step forward for diagnosis.1 These Task Force criteria emphasized the role of quantitative imaging for both echocardiography and cardiac magnetic resonance imaging (CMR). In particular, multicenter study data were used to generate sex-specific cut-off values that distinguished borderline and definite ARVC for volumetric CMR data. The Task Force criteria were established to achieve high specificity of an imaging feature (eg, right ventricular (RV) volume or ejection fraction) at approximately the 95th percentile. That relatively high specificity resulted in lower sensitivity (68% to 76%) for CMR criteria in the original North American ARVC/D Registry.1 Major CMR criteria include RV ejection fraction ≤40% or RV end-diastolic index ≥110 mL/m2 for men or 100 mL/m2 for women. The rationale for choosing stringent criteria for any one diagnostic test, such as CMR, is that the combination of several criteria is used for the final diagnosis of disease. The use of several diagnostic criteria (structural changes, tissue characterization, arrhythmia, repolarization abnormalities, and family history) is the current standard of care for diagnosis of ARVC/D.See Article by Prati et al The task force criteria for CMR require a regional wall motion abnormality to be present (in addition …