Arrhythmogenic Right Ventricular Cardiomyopathy Diagnosis

A late-onset arrhythmogenic right ventricular cardiomyopathy unveiled by supraventricular tachycardia: Case report

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare myocardial genetic disease that leads to heart failure and sudden cardiac death. The diagnosis of ARVC remains challenging given its variable presentation. A 66-year-old woman was admitted to our cardiac intensive care unit for the management of a left heart failure flare-up with an atrial flutter, which remains an atypical mode of the revelation of arrhythmogenic right ventricular cardiomyopathy (ARVC) retained based the association of genetic predisposition, the presence of repolarization abnormalities on electrocardiogram (EKG), the occurrence of an episode of sustained ventricular tachycardia and imaging data. ARVC is a condition with varying expressions, severity, and progression. Early detection, careful monitoring, and appropriate management are crucial in improving outcomes for individuals with ARVC.

Multimodality imaging for the diagnosis of left ventricular apical hypoplasia: A case presentation and review of the literatures

Left ventricular apical hypoplasia is a rare malformation recently described congenital abnormality characterized by: (1) truncation of the left ventricle, with the septum projecting toward the right ventricle; (2) abnormal papillary muscle originating from the flattened left ventricular apex; (3) a narrow right ventricle encompassing the periapical area of the left ventricle; (4) fatty infiltration of the apex of the left ventricle. We reported a case of LVAH and reviewed the patient's clinical presentation. And its morphologic characteristics were revealed by multimodality imaging, including echocardiography and cardiac magnetic resonance imaging. Additionally, we reviewed 41 cases from 32 reports to summarize the pathogenesis and analyzed the imaging manifestations of LVAH in this study, aiming to provide new ideas for the diagnosis and clinical management of LVAH patients.

Arrhythmogenic Right Ventricular Cardiomyopathy Post-Mortem Assessment: A Systematic Review

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterized by the progressive fibro-fatty replacement of the right ventricular myocardium, leading to myocardial atrophy. Although the structural changes usually affect the right ventricle, the pathology may also manifest with either isolated left ventricular myocardium or biventricular involvement. As ARVC shows an autosomal dominant pattern of inheritance with variable penetrance, the clinical presentation of the disease is highly heterogeneous, with different degrees of severity and patterns of myocardial involvement even in patients of the same familiar group with the same gene mutation: the pathology spectrum ranges from the absence of symptoms to sudden cardiac death (SCD) sustained by ventricular arrhythmias, which may, in some cases, be the first manifestation of an otherwise silent pathology. An evidence-based systematic review of the literature was conducted to evaluate the state of the art of the diagnostic techniques for the correct post-mortem identification of ARVC. The research was performed using the electronic databases PubMed and Scopus. A methodological approach to reach a correct post-mortem diagnosis of ARVC was described, analyzing the main post-mortem peculiar macroscopic, microscopic and radiological alterations. In addition, the importance of performing post-mortem genetic tests has been underlined, which may lead to the correct identification and characterization of the disease, especially in those ARVC forms where anatomopathological investigation does not show evident morphostructural damage. Furthermore, the usefulness of genetic testing is not exclusively limited to the correct diagnosis of the pathology, but is essential for promoting targeted screening programs to the deceased's family members. Nowadays, the post-mortem diagnosis of ARVC performed by forensic pathologist remains very challenging: therefore, the identification of a clear methodological approach may lead to both a reduction in under-diagnoses and to the improvement of knowledge on the disease.

Development of an Expert-Level Right Ventricular Abnormality Detection Algorithm Based on Deep Learning

PURPOSE

Studies relating to the right ventricle (RV) are inadequate, and specific diagnostic algorithms still need to be improved. This essay is designed to make exploration and verification on an algorithm of deep learning based on imaging and clinical data to detect RV abnormalities.

METHODS

The Automated Cardiac Diagnosis Challenge dataset includes 20 subjects with RV abnormalities (an RV cavity volume which is higher than 110 mL/m2 or RV ejection fraction which is lower than 40%) and 20 normal subjects who suffered from both cardiac MRI. The subjects were separated into training and validation sets in a ratio of 7:3 and were modeled by utilizing a nerve net of deep-learning and six machine-learning algorithms. Eight MRI specialists from multiple centers independently determined whether each subject in the validation group had RV abnormalities. Model performance was evaluated based on the AUC, accuracy, recall, sensitivity and specificity. Furthermore, a preliminary assessment of patient disease risk was performed based on clinical information using a nomogram.

RESULTS

The deep-learning neural network outperformed the other six machine-learning algorithms, with an AUC value of 1 (95% confidence interval: 1-1) on both training group and validation group. This algorithm surpassed most human experts (87.5%). In addition, the nomogram model could evaluate a population with a disease risk of 0.2-0.8.

CONCLUSIONS

A deep-learning algorithm could effectively identify patients with RV abnormalities. This AI algorithm developed specifically for right ventricular abnormalities will improve the detection of right ventricular abnormalities at all levels of care units and facilitate the timely diagnosis and treatment of related diseases. In addition, this study is the first to validate the algorithm's ability to classify RV abnormalities by comparing it with human experts.

THE KEY-STONES OF RIGHT VENTRICULAR ARRHYTHMOGENIC CARDIOMYOPATHY-INDUCED MORPHOLOGICAL DISARRANGEMENT

Arrhythmogenic right ventricular cardiomyopathy is an urgent problem of modern cardiology. This myocardial remodeling manifests various desmosomopathies, channelopathies, and other mutations resulting in a violation of the coordinated heart work, particularly the myocardium. The incidence of this cardiomyopathy is not significant. Still, it is worth noting that athletes are at an increased risk of developing this disease, emphasizing the importance of studying this topic and its relevance from cardiologists and sports physicians. Moreover, the clinical pattern of this disease is heterogeneous. This pathology requires strengthening control and attention of medical personnel and constant improvement and optimization of diagnostic methods and treatment protocols. In this article, the pathophysiological mechanisms, molecular genetic aspects, and the dynamics of morphofunctional changes are represented in detail. Understanding the mechanisms of etiopathogenesis and the features of morphological changes observed in this cardiomyopathy and its more detailed study is fundamental in developing modern treatment methods to improve patients' quality and life expectancy.