Prolonged Electromechanical Interval Unmasks Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy in the Subclinical Stage.

Autor:	MAST, THOMAS P., TESKE, ARCO J., RIELE, ANNELINE SJM, GROENEWEG, JUDITH A., HEIJDEN, JEROEN F., VELTHUIS, BIRGITTA K., LOH, PETER, DOEVENDANS, PIETER A., VEEN, TOON A., DOOIJES, DENNIS, BAKKER, JACQUES M., HAUER, RICHARD N., CRAMER, MAARTEN J.
Předmět:	ACADEMIC medical centers ANALYSIS of variance CHI-squared test COMPARATIVE studies CONGENITAL heart disease STATISTICAL correlation DIAGNOSTIC imaging ECHOCARDIOGRAPHY FISHER exact test RIGHT heart ventricle MAGNETIC resonance imaging GENETIC mutation PROBABILITY theory RESEARCH funding T-test (Statistics) TRICUSPID valve GENETIC testing RECEIVER operating characteristic curves GENETIC carriers DATA analysis software DESCRIPTIVE statistics KAPLAN-Meier estimator VENTRICULAR arrhythmia LOG-rank test MANN Whitney U Test ARRHYTHMOGENIC right ventricular dysplasia KRUSKAL-Wallis Test SYMPTOMS PHYSIOLOGY
Zdroj:	Journal of Cardiovascular Electrophysiology; Mar2016, Vol. 27 Issue 3, p303-314, 12p
Abstrakt:	Electromechanical Interval in Subclinical ARVD/C Introduction Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is characterized by high incidence of ventricular arrhythmias. Overt ARVD/C is preceded by a subclinical stage with lack of detectable ECG and structural abnormalities. Activation delay is present before structural abnormalities and is a hallmark of arrhythmogenesis. Deformation imaging may unmask activation delay in the subclinical stage. Methods Three groups were compared: (1) mutation-positive definite ARVD/C-patients fulfilling 2010 Task Force criteria (TFC) (n = 44); (2) asymptomatic mutation carriers not fulfilling TFC and without history of ventricular arrhythmias (n = 31); and (3) controls (n = 30). All underwent ECG and echocardiographic deformation imaging. As a surrogate for local activation delay the electromechanical interval (EMI) was measured, defined as time between onset-QRS and onset of shortening. Arrhythmic outcome (PVC-count, VT) of asymptomatic mutation carriers was correlated with EMI and ECG TFC. Results In definite ARVD/C-patients, EMI was prolonged in all lateral RV segments. In asymptomatic mutation carriers, prolonged EMI was detected in the subtricuspid area in 14/31. Terminal activation duration ≥55 milliseconds (definition: supporting information) was the only ECG abnormality in this group (8/31). After a mean follow-up of 4.2 ± 3.1 years 10/31 asymptomatic mutation carriers experienced arrhythmic outcome. Prolonged subtricuspid EMI was the only parameter significantly associated with arrhythmogenesis during follow-up. Conclusion In ARVD/C-patients, EMI prolongation was present throughout the RV. In asymptomatic mutation carriers, prolonged EMI in the subtricuspid area is often detected without any additional abnormalities. These preliminary results indicate that prolonged EMI is a new parameter unmasking activation delay in the subclinical stage and may contribute to risk stratification. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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