Yield of Serial Evaluation in At-Risk Family Members of Patients With ARVD/C

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:64

Article

te Riele, Anneline S. J. M.^1,2  James, Cynthia A.²  Rastegar, Neda³  Bhonsale, Aditya²  Murray, Brittney²  Tichnell, Crystal²  Judge, Daniel P.²  Bluemke, David A.^3,4  Zimmerman, Stefan L.²  Kamel, Ihab R.²  Calkins, Hugh²  Tandri, Harikrishna² 

[1] Univ Med Ctr Utrecht, Div Cardiol, Dept Med, Utrecht, Netherlands

[2] Johns Hopkins Univ, Sch Med, Dept Med, Div Cardiol, Baltimore, MD 21205 USA

[3] Johns Hopkins Univ, Sch Med, Dept Radiol, Baltimore, MD 21205 USA

[4] Natl Inst Hlth Clin Ctr, Bethesda, MD USA

关键词: cardiomyopathy;    electrocardiography;    magnetic resonance imaging;    progression;    screening;   

DOI  :  10.1016/j.jacc.2014.04.044

来源: Elsevier

【 摘 要 】

BACKGROUND Incomplete penetrance and variable expressivity of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) complicate family screening. OBJECTIVES The objective of the present study was to determine the optimal approach to longitudinal follow-up regarding: 1) screening interval; and 2) testing strategy in at-risk relatives of ARVD/C patients. METHODS We included 117 relatives (45% male, age 33.3 +/- 16.3 years) from 64 families who were at risk of developing ARVD/C by virtue of their familial predisposition (72% mutation carriers [92% plakophilin-2]; 28% first-degree relatives of a mutation-negative proband). Subjects were evaluated by electrocardiography (ECG), Holter monitoring, signal-averaged ECG, and cardiac magnetic resonance (CMR). Disease progression was defined as the development of a new criterion by the 2010 Task Force Criteria (not the Hamid criteria) at last follow-up that was absent at enrollment. RESULTS At first evaluation, 43 subjects (37%) fulfilled an ARVD/C diagnosis according to the 2010 Task Force Criteria. Among the remaining 74 subjects (63%), 11 of 37 (30%) with complete re-evaluation experienced disease progression during 4.1 +/- 2.3 years of follow-up. Electrical progression (n = 10 [27%], including by ECG [14%], Holter monitoring [11%], or signal-averaged ECG [14%]) was more frequently observed than structural progression (n 1 [3%] on CMR). All 5 patients (14%) with clinical ARVD/C diagnosis at last follow-up had an abnormal ECG or Holter monitor recording, and the only patient with an abnormal CMR already had an abnormal ECG at enrollment. CONCLUSIONS Over a mean follow-up of 4 years, our study showed that: 1) almost one-third of at-risk relatives have electrical progression; 2) structural progression is rare; and 3) electrical abnormalities precede detectable structural changes. This information could be valuable in determining family screening protocols. (C) 2014 by the American College of Cardiology Foundation.

【 授权许可】

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