Arrhythmogenic ventricular disease: 45 patients studied with magnetic resonance

Ventricular tachycardias, sometimes responsible for a syncope, may represent the first sign of an unknown cardiomyopathy; fewer data are reported on its pathological substrate. However the extent of the anatomical lesion is responsible for the clinical and haemodynamic setting. Two-dimensional echocardiography and angiography are the current methods to assess the degree of the anatomical and functional impairment; these two methods allow the diagnosis only in case of overt disease, whereas limited involvement is hardly detected. The aim of this study was to verify the diagnostic power of magnetic resonance (MR) in the definition of gross morphological pattern, functional impairment and tissue characterization in these patients, particularly in cases with apparently normal heart. Sixty subjects were included in the study: 45 (33 males, 12 females, aged 14-64 years), were arrhythmic patients with bioptical diagnosis (15 patients) or clinical suspicion (30 patients) of arrhythmogenic ventricular disease. The other 15 subjects were normal subjects and were included as a control group. MR was performed, by means of a 1.5 T Philips Gyroscan, using spin echo technique, on axial and short axis sections; gradient echo sequencies on a four-chamber view, were then performed for evaluation of the systolic right and left ventricular function. Adipose or fibro-adipose degeneration were detected in the right ventricle, the left ventricle or both. Right, left or biventricular dysfunction were detected in a minority of patients, as well as modifications of the right ventricular wall thickness. All the control subjects were normal at MR. In conclusion, MR was able to document a wide spectrum of right and left ventricle morphologic and functional changes; the most striking feature was the demonstration of fatty replacement of the myocardium. Segmentary involvement could be evidenced event in normal hearts.