Echocardiographic assessment of arrhythmogenic right ventricular cardiomyopathy

Objective-To evaluate new echocardiographic modes in the diagnosis of arrhy thmogenic right ventricular cardiomyopathy (ARVC). Design-Prospective observational study. Setting-University Hospital. Subjects-15 patients with ARVC and a control group of 25 healthy subjects. Methods-Transthoracic echocardiography included cross sectional measurement s of the right ventricular outflow tract, right ventricular inflow tract, a nd right ventricular body. Wall motion was analysed subjectively. M mode an d pulsed tissue Doppler techniques were used for quantitative measurement o f tricuspid annular motion at the lateral, septal, posterior, and anterior positions. Doppler assessment of tricuspid flow and systemic venous flow wa s also performed. Results-Assessed by M mode, the total amplitude of the tricuspid annular mo tion was significantly decreased in the lateral, septal, and posterior posi tions in the patients compared with the controls. The tissue Doppler veloci ty pattern showed decreased early diastolic peak annular (E-A) velocity and an accompanying decrease in early (E-A) to late diastolic (A(A)) velocity ratio in all positions; the systolic annular velocity was significantly dec reased only in the lateral position. Four patients had normal right ventric ular dimensions and three were judged to have normal right ventricular wall motion. The patient group had also a significantly decreased tricuspid flo w E:A ratio. Conclusions-Tricuspid annular measurements are valuable, easy to obtain, an d allow quantitative assessment of right ventricular function. ARVC patient s showed an abnormal velocity pattern that may be an early but non-specific sign of the disease. Normal right ventricular dimensions do not exclude AR VC, and subjective detection of early changes in wall motion may be difficu lt.