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Impact of revised Task Force Criteria: distinguishing the athlete’s heart from ARVC/D using cardiac magnetic resonance imaging
Background: Cardiac magnetic resonance (CMR) evaluation of athletes for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is complicated by overlapping features such as right ventricular (RV) volume increase. The revised ARVC/D diagnostic Task Force Criteria (TFC) incorporate cut-of...
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| Published in: | European journal of preventive cardiology 2012-08, Vol.19 (4), p.885-891 |
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| container_title | European journal of preventive cardiology |
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| creator | Luijkx, Tim Velthuis, Birgitta K Prakken, Niek HJ Cox, Moniek GPJ Bots, Michiel L Mali, Willem PThM Hauer, Richard NW Cramer, Maarten J |
| description | Background: Cardiac magnetic resonance (CMR) evaluation of athletes for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is complicated by overlapping features such as right ventricular (RV) volume increase. The revised ARVC/D diagnostic Task Force Criteria (TFC) incorporate cut-off values for RV ejection fraction (EF) and RV end-diastolic volume (EDV) on CMR.
Design: To distinguish ARVC/D patients from athletes we compared CMR ventricular volumes, function, TFC cut-off values, and LV/RV ratios since athletes show proportionate, and ARVC/D patients disproportionate, changes in LV and RV.
Methods: Quantitative CMR parameters of 33 ARVC/D patients (64% male, mean age 45.4 years, diagnosed by revised TFC), 66 healthy athletes and 66 healthy non-athletes (sex and age matched) were compared using revised TFC and new cut-off values representing LV/RV balance.
Results and conclusions: Absolute values for ARVC/D patients/athletes/non-athletes were: in males, RV EDV 149/133/106 ml/m2, ratio EDV LV/RV 0.70/0.91/0.93, RV EF 34/52/54%, LV EF 48/57/58%, ratio EF LV/RV 1.49/1.10/1.09; and in females, RV EDV 115/115/91 ml/m2, ratio EDV LV/RV 0.86/0.94/0.97, RV EF 43/54/58%, LV EF 52/57/61%, ratio EF LV/RV 1.23/1.08/1.04 (p-values |
| doi_str_mv | 10.1177/1741826711414215 |
| format | article |
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Design: To distinguish ARVC/D patients from athletes we compared CMR ventricular volumes, function, TFC cut-off values, and LV/RV ratios since athletes show proportionate, and ARVC/D patients disproportionate, changes in LV and RV.
Methods: Quantitative CMR parameters of 33 ARVC/D patients (64% male, mean age 45.4 years, diagnosed by revised TFC), 66 healthy athletes and 66 healthy non-athletes (sex and age matched) were compared using revised TFC and new cut-off values representing LV/RV balance.
Results and conclusions: Absolute values for ARVC/D patients/athletes/non-athletes were: in males, RV EDV 149/133/106 ml/m2, ratio EDV LV/RV 0.70/0.91/0.93, RV EF 34/52/54%, LV EF 48/57/58%, ratio EF LV/RV 1.49/1.10/1.09; and in females, RV EDV 115/115/91 ml/m2, ratio EDV LV/RV 0.86/0.94/0.97, RV EF 43/54/58%, LV EF 52/57/61%, ratio EF LV/RV 1.23/1.08/1.04 (p-values < 0.05). Areas under the ROC-curve are 0.68 (RV EDV index), 0.84 (LV/RV EDV ratio) and 0.93 (RV EF), demonstrating significantly (p < 0.001) better performance of RV EF and LV/RV EDV ratio. If a wall motion abnormality is present (observed in 30 ARVC/D patients and not in healthy subjects), RV EF can help distinguish ARVC/D from physiological cardiac adaptation in athletes on CMR whereas RV EDV index cannot. A good alternative in athletes is the LV/RV EDV ratio, representing normal proportionate adaptation of both ventricles.</description><identifier>ISSN: 2047-4873</identifier><identifier>EISSN: 2047-4881</identifier><identifier>DOI: 10.1177/1741826711414215</identifier><identifier>PMID: 21690305</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Analysis of Variance ; Arrhythmogenic Right Ventricular Dysplasia - diagnosis ; Arrhythmogenic Right Ventricular Dysplasia - pathology ; Arrhythmogenic Right Ventricular Dysplasia - physiopathology ; Cardiomegaly - diagnosis ; Cardiomegaly - etiology ; Cardiomegaly - pathology ; Cardiomegaly - physiopathology ; Cardiomegaly, Exercise-Induced ; Case-Control Studies ; Diagnosis, Differential ; Female ; Heart Ventricles - pathology ; Heart Ventricles - physiopathology ; Humans ; Magnetic Resonance Imaging, Cine - standards ; Male ; Middle Aged ; Netherlands ; Practice Guidelines as Topic ; Predictive Value of Tests ; ROC Curve ; Stroke Volume ; Ventricular Function, Left ; Ventricular Function, Right</subject><ispartof>European journal of preventive cardiology, 2012-08, Vol.19 (4), p.885-891</ispartof><rights>The European Society of Cardiology 2011 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c379t-ef630edb59541833da8ad31f80d8ca95d6cfaef764116bce0456f4783dd0deb13</citedby><cites>FETCH-LOGICAL-c379t-ef630edb59541833da8ad31f80d8ca95d6cfaef764116bce0456f4783dd0deb13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21690305$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luijkx, Tim</creatorcontrib><creatorcontrib>Velthuis, Birgitta K</creatorcontrib><creatorcontrib>Prakken, Niek HJ</creatorcontrib><creatorcontrib>Cox, Moniek GPJ</creatorcontrib><creatorcontrib>Bots, Michiel L</creatorcontrib><creatorcontrib>Mali, Willem PThM</creatorcontrib><creatorcontrib>Hauer, Richard NW</creatorcontrib><creatorcontrib>Cramer, Maarten J</creatorcontrib><title>Impact of revised Task Force Criteria: distinguishing the athlete’s heart from ARVC/D using cardiac magnetic resonance imaging</title><title>European journal of preventive cardiology</title><addtitle>Eur J Prev Cardiol</addtitle><description>Background: Cardiac magnetic resonance (CMR) evaluation of athletes for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is complicated by overlapping features such as right ventricular (RV) volume increase. The revised ARVC/D diagnostic Task Force Criteria (TFC) incorporate cut-off values for RV ejection fraction (EF) and RV end-diastolic volume (EDV) on CMR.
Design: To distinguish ARVC/D patients from athletes we compared CMR ventricular volumes, function, TFC cut-off values, and LV/RV ratios since athletes show proportionate, and ARVC/D patients disproportionate, changes in LV and RV.
Methods: Quantitative CMR parameters of 33 ARVC/D patients (64% male, mean age 45.4 years, diagnosed by revised TFC), 66 healthy athletes and 66 healthy non-athletes (sex and age matched) were compared using revised TFC and new cut-off values representing LV/RV balance.
Results and conclusions: Absolute values for ARVC/D patients/athletes/non-athletes were: in males, RV EDV 149/133/106 ml/m2, ratio EDV LV/RV 0.70/0.91/0.93, RV EF 34/52/54%, LV EF 48/57/58%, ratio EF LV/RV 1.49/1.10/1.09; and in females, RV EDV 115/115/91 ml/m2, ratio EDV LV/RV 0.86/0.94/0.97, RV EF 43/54/58%, LV EF 52/57/61%, ratio EF LV/RV 1.23/1.08/1.04 (p-values < 0.05). Areas under the ROC-curve are 0.68 (RV EDV index), 0.84 (LV/RV EDV ratio) and 0.93 (RV EF), demonstrating significantly (p < 0.001) better performance of RV EF and LV/RV EDV ratio. If a wall motion abnormality is present (observed in 30 ARVC/D patients and not in healthy subjects), RV EF can help distinguish ARVC/D from physiological cardiac adaptation in athletes on CMR whereas RV EDV index cannot. A good alternative in athletes is the LV/RV EDV ratio, representing normal proportionate adaptation of both ventricles.</description><subject>Adult</subject><subject>Analysis of Variance</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - diagnosis</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - pathology</subject><subject>Arrhythmogenic Right Ventricular Dysplasia - physiopathology</subject><subject>Cardiomegaly - diagnosis</subject><subject>Cardiomegaly - etiology</subject><subject>Cardiomegaly - pathology</subject><subject>Cardiomegaly - physiopathology</subject><subject>Cardiomegaly, Exercise-Induced</subject><subject>Case-Control Studies</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Heart Ventricles - pathology</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging, Cine - standards</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Netherlands</subject><subject>Practice Guidelines as Topic</subject><subject>Predictive Value of Tests</subject><subject>ROC Curve</subject><subject>Stroke Volume</subject><subject>Ventricular Function, Left</subject><subject>Ventricular Function, Right</subject><issn>2047-4873</issn><issn>2047-4881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNp1kMFOwzAMhiMEgmnszgnlyKWQNG2TcpsGg0mTkBBwrbLEWQNrO5IUiRuvwevxJGQa7ICEL7asz7_tH6ETSs4p5fyC8oyKtOCUZjRLab6HBinJeJIJQfd3NWdHaOT9M4lRkDQV4hAdpbQoCSP5AH3MmrVUAXcGO3izHjR-kP4FTzunAE-cDeCsvMTa-mDbZW99HRMONWAZ6hUE-Pr49LgG6QI2rmvw-P5pcnGFe7_hlHTaSoUbuWwhWBWX-K6VbdS2sReRY3Rg5MrD6CcP0eP0-mFym8zvbmaT8TxRjJchAVMwAnqRl3n8mjEthdSMGkG0ULLMdaGMBMOLjNJioYBkeWEyLpjWRMOCsiE62-quXffagw9VY72C1Uq20PW-oiTljJO4JaJkiyrXee_AVGsXr3XvEao21ld_rY8jpz_q_aIBvRv4NToCyRbwcgnVc9e7Nn77v-A3E1eNLA</recordid><startdate>201208</startdate><enddate>201208</enddate><creator>Luijkx, Tim</creator><creator>Velthuis, Birgitta K</creator><creator>Prakken, Niek HJ</creator><creator>Cox, Moniek GPJ</creator><creator>Bots, Michiel L</creator><creator>Mali, Willem PThM</creator><creator>Hauer, Richard NW</creator><creator>Cramer, Maarten J</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201208</creationdate><title>Impact of revised Task Force Criteria: distinguishing the athlete’s heart from ARVC/D using cardiac magnetic resonance imaging</title><author>Luijkx, Tim ; Velthuis, Birgitta K ; Prakken, Niek HJ ; Cox, Moniek GPJ ; Bots, Michiel L ; Mali, Willem PThM ; Hauer, Richard NW ; Cramer, Maarten J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c379t-ef630edb59541833da8ad31f80d8ca95d6cfaef764116bce0456f4783dd0deb13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Analysis of Variance</topic><topic>Arrhythmogenic Right Ventricular Dysplasia - diagnosis</topic><topic>Arrhythmogenic Right Ventricular Dysplasia - pathology</topic><topic>Arrhythmogenic Right Ventricular Dysplasia - physiopathology</topic><topic>Cardiomegaly - diagnosis</topic><topic>Cardiomegaly - etiology</topic><topic>Cardiomegaly - pathology</topic><topic>Cardiomegaly - physiopathology</topic><topic>Cardiomegaly, Exercise-Induced</topic><topic>Case-Control Studies</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Heart Ventricles - pathology</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging, Cine - standards</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Netherlands</topic><topic>Practice Guidelines as Topic</topic><topic>Predictive Value of Tests</topic><topic>ROC Curve</topic><topic>Stroke Volume</topic><topic>Ventricular Function, Left</topic><topic>Ventricular Function, Right</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luijkx, Tim</creatorcontrib><creatorcontrib>Velthuis, Birgitta K</creatorcontrib><creatorcontrib>Prakken, Niek HJ</creatorcontrib><creatorcontrib>Cox, Moniek GPJ</creatorcontrib><creatorcontrib>Bots, Michiel L</creatorcontrib><creatorcontrib>Mali, Willem PThM</creatorcontrib><creatorcontrib>Hauer, Richard NW</creatorcontrib><creatorcontrib>Cramer, Maarten J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of preventive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luijkx, Tim</au><au>Velthuis, Birgitta K</au><au>Prakken, Niek HJ</au><au>Cox, Moniek GPJ</au><au>Bots, Michiel L</au><au>Mali, Willem PThM</au><au>Hauer, Richard NW</au><au>Cramer, Maarten J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of revised Task Force Criteria: distinguishing the athlete’s heart from ARVC/D using cardiac magnetic resonance imaging</atitle><jtitle>European journal of preventive cardiology</jtitle><addtitle>Eur J Prev Cardiol</addtitle><date>2012-08</date><risdate>2012</risdate><volume>19</volume><issue>4</issue><spage>885</spage><epage>891</epage><pages>885-891</pages><issn>2047-4873</issn><eissn>2047-4881</eissn><abstract>Background: Cardiac magnetic resonance (CMR) evaluation of athletes for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is complicated by overlapping features such as right ventricular (RV) volume increase. The revised ARVC/D diagnostic Task Force Criteria (TFC) incorporate cut-off values for RV ejection fraction (EF) and RV end-diastolic volume (EDV) on CMR.
Design: To distinguish ARVC/D patients from athletes we compared CMR ventricular volumes, function, TFC cut-off values, and LV/RV ratios since athletes show proportionate, and ARVC/D patients disproportionate, changes in LV and RV.
Methods: Quantitative CMR parameters of 33 ARVC/D patients (64% male, mean age 45.4 years, diagnosed by revised TFC), 66 healthy athletes and 66 healthy non-athletes (sex and age matched) were compared using revised TFC and new cut-off values representing LV/RV balance.
Results and conclusions: Absolute values for ARVC/D patients/athletes/non-athletes were: in males, RV EDV 149/133/106 ml/m2, ratio EDV LV/RV 0.70/0.91/0.93, RV EF 34/52/54%, LV EF 48/57/58%, ratio EF LV/RV 1.49/1.10/1.09; and in females, RV EDV 115/115/91 ml/m2, ratio EDV LV/RV 0.86/0.94/0.97, RV EF 43/54/58%, LV EF 52/57/61%, ratio EF LV/RV 1.23/1.08/1.04 (p-values < 0.05). Areas under the ROC-curve are 0.68 (RV EDV index), 0.84 (LV/RV EDV ratio) and 0.93 (RV EF), demonstrating significantly (p < 0.001) better performance of RV EF and LV/RV EDV ratio. If a wall motion abnormality is present (observed in 30 ARVC/D patients and not in healthy subjects), RV EF can help distinguish ARVC/D from physiological cardiac adaptation in athletes on CMR whereas RV EDV index cannot. A good alternative in athletes is the LV/RV EDV ratio, representing normal proportionate adaptation of both ventricles.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>21690305</pmid><doi>10.1177/1741826711414215</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Analysis of Variance Arrhythmogenic Right Ventricular Dysplasia - diagnosis Arrhythmogenic Right Ventricular Dysplasia - pathology Arrhythmogenic Right Ventricular Dysplasia - physiopathology Cardiomegaly - diagnosis Cardiomegaly - etiology Cardiomegaly - pathology Cardiomegaly - physiopathology Cardiomegaly, Exercise-Induced Case-Control Studies Diagnosis, Differential Female Heart Ventricles - pathology Heart Ventricles - physiopathology Humans Magnetic Resonance Imaging, Cine - standards Male Middle Aged Netherlands Practice Guidelines as Topic Predictive Value of Tests ROC Curve Stroke Volume Ventricular Function, Left Ventricular Function, Right |
| title | Impact of revised Task Force Criteria: distinguishing the athlete’s heart from ARVC/D using cardiac magnetic resonance imaging |
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