Author + information
- Received February 24, 2009
- Revision received April 6, 2009
- Accepted April 14, 2009
- Published online July 28, 2009.
- Laurens F. Tops, MD⁎,‡,
- Kalpana Prakasa, MD⁎,
- Harikrishna Tandri, MD⁎,
- Darshan Dalal, MD⁎,
- Rahul Jain, MD⁎,
- Veronica L. Dimaano, MD⁎,
- David Dombroski, MD†,
- Cynthia James, PhD⁎,
- Crystal Tichnell, MGC⁎,
- Amy Daly, MSc⁎,
- Frank Marcus, MD§,
- Martin J. Schalij, MD‡,
- Jeroen J. Bax, MD‡,
- David Bluemke, MD†,
- Hugh Calkins, MD⁎ and
- Theodore P. Abraham, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Theodore P. Abraham, Johns Hopkins University, 600 North Wolfe Street, Carnegie 568, Baltimore, Maryland 21287
Objectives This study sought to investigate the prevalence and mechanisms underlying right ventricular (RV) dyssynchrony in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) using tissue Doppler echocardiography (TDE).
Background An ARVD/C is characterized by fibrofatty replacement of RV myocardium and RV dilation. These pathologic changes may result in electromechanical dyssynchrony.
Methods Echocardiography, both conventional and TDE, was performed in 52 ARVD/C patients fulfilling Task Force criteria and 25 control subjects. The RV end-diastolic and -systolic areas, right ventricular fractional area change (RVFAC), and left ventricular (LV) volumes and function were assessed. Mechanical synchrony was assessed by measuring differences in time-to-peak systolic velocity (TSV) between the RV free wall, ventricular septum, and LV lateral wall. An RV dyssynchrony was defined as the difference in TSVbetween the RV free wall and the ventricular septum, >2 SD above the mean value for control subjects.
Results The mean difference in RV TSVwas higher in ARVD/C compared with control subjects (55 ± 34 ms vs. 26 ± 15 ms, p < 0.001). Significant RV dyssynchrony was not noted in any of the control subjects. Based on a cutoff value of 56 ms, significant RV dyssynchrony was present in 26 ARVD/C patients (50%). Patients with RV dyssynchrony had a larger RV end-diastolic area (22 ± 5 cm2vs. 19 ± 4 cm2, p = 0.02), and lower RVFAC (29 ± 8% vs. 34 ± 8%, p = 0.03) compared with ARVD/C patients without RV dyssynchrony. No differences in QRS duration, LV volumes, or function were present between the 2 groups.
Conclusions An RV dyssynchrony may occur in up to 50% of ARVD/C patients, and is associated with RV remodeling. This finding may have therapeutic and prognostic implications in ARVD/C.
This work was supported by funds from the Bogle Foundation, National Institutes of Health (HL65594 and AG22554), The Netherlands Heart Foundation, Leids Universiteits Fonds, and Foundation De Drie Lichten. Dr. Bax has received grants from Medtronic, Biotronik, Bristol-Myers Squibb Medical Imaging, St. Jude Medical, GE Healthcare, and Edwards Lifesciences. Dr. Abraham has received honoraria and research grants from GE Healthcare. Drs. Tops and Prakasa contributed equally to this work.
- Received February 24, 2009.
- Revision received April 6, 2009.
- Accepted April 14, 2009.
- American College of Cardiology Foundation