1b7f613b271c69840f26c191c0390c39 299282.pdf e054fb76f01e2adac48b026bebd3f7e0964ce13b 299282.pdf fb34712de8eb72d6eda866096ddf3ba47563a2cb2e9579ee66a9e7e393c3cdee 299282.pdf Title: Diagnostic and Prognostic Value of Right Ventricular Fat Quantification from Computed Tomography in Arrhythmogenic Right Ventricular Cardiomyopathy Subject: Background: In arrhythmogenic right ventricular cardiomyopathy (ARVC) non-invasive scar evaluation is not included among the diagnostic criteria or the predictors of ventricular arrhythmias (VA) and sudden death (SD). Computed tomography (CT) has excellent spatial resolution and allows a clear distinction between myocardium and fat; thus, it has great potential for the evaluation of myocardial scar in ARVC. Objective: The objective of this study is to evaluate the feasibility, and the diagnostic and prognostic value of semi-automated quantification of right ventricular (RV) fat replacement from CT images. Methods: An observational case–control study was carried out including 23 patients with a definite (19) or borderline (4) ARVC diagnosis and 23 age- and sex-matched controls without structural heart disease. All patients underwent contrast-enhanced cardiac CT. RV images were semi-automatically reconstructed with the ADAS-3D software (ADAS3D Medical, Barcelona, Spain). A fibrofatty scar was defined as values of Hounsfield Units (HU) <-10. Within the scar, a border zone (between -10 HU and -50 HU) and dense scar (<-50 HU) were distinguished. Results: All ARVC patients had an RV scar and all scar-related measurements were significantly higher in ARVC cases than in controls (p < 0.001). The total scar area and dense scar area showed no overlapping values between cases and controls, achieving perfect diagnostic performance (sensitivity and specificity of 100%). Among ARVC patients, 16 (70%) had experienced sustained VA or aborted SD. Among all clinical, ECG and imaging parameters, the dense scar area was the only one with a statistically significant association with VA and SD (p = 0.003). Conclusions: In ARVC, RV myocardial fat quantification from CT is feasible and may have considerable diagnostic and prognostic value. Keywords: arrhythmogenic right ventricular cardiomyopathy; cardiac computed tomography;ventricular arrhythmias; sudden death; myocardial fibrofatty replacement Author: Valentina Faga, María Ruiz Cueto, David Viladés Medel, Zoraida Moreno-Weidmann, Paolo D. Dallaglio, Carles Diez Lopez, Gerard Roura, Jose M. Guerra, Rubén Leta Petracca, Joan Antoni Gomez-Hospital, Josep Comin Colet, Ignasi Anguera and Andrea Di Marco Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Jul 10 03:10:42 2024 CEST ModDate: Wed Jul 10 03:31:44 2024 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 16 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 4253394 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- YSPQJI+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 VHATZG+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 VTYBOF+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 LZDURF+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 SOSCBV+CMSY10 Type 1 Builtin yes yes yes 32 0 UZLFPZ+VnURWPalladioL Type 1 Custom yes yes yes 37 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 53 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 56 0 GGHGAI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 88 0 GGHGAJ+PalatinoLinotype CID TrueType Identity-H yes yes yes 91 0 GGHGAK+PalatinoLinotype TrueType WinAnsi yes yes no 97 0 GGHGAM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 100 0 GGHHIH+PalatinoLinotype TrueType MacRoman yes yes no 115 0 GGHGAI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 118 0 GGHGAJ+PalatinoLinotype CID TrueType Identity-H yes yes yes 121 0 GGHGAK+PalatinoLinotype TrueType WinAnsi yes yes no 127 0 GGHGAM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 130 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 137 0 GGHHIH+PalatinoLinotype TrueType MacRoman yes yes no 150 0 GGIDJA+Cambria CID TrueType Identity-H yes yes yes 153 0 GGHGAI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 159 0 GGHGAK+PalatinoLinotype TrueType WinAnsi yes yes no 162 0 GGHGAM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 165 0 GGHHGG+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 168 0 GGHHIH+PalatinoLinotype TrueType MacRoman yes yes no 184 0 GGHGAI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 187 0 GGHGAJ+PalatinoLinotype CID TrueType Identity-H yes yes yes 190 0 GGHGAK+PalatinoLinotype TrueType WinAnsi yes yes no 196 0 GGHGAM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 199 0 GGHHIH+PalatinoLinotype TrueType MacRoman yes yes no 213 0 GGHGAI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 216 0 GGHGAJ+PalatinoLinotype CID TrueType Identity-H yes yes yes 219 0 GGHGAK+PalatinoLinotype TrueType WinAnsi yes yes no 225 0 GGHGAM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 228 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-12-12 02:48:47 CET RepresentationInformation: 299282.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-12-10 09:33:03 CET Size: 4253394 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 389 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Children: Item: Title: Cardiac CT Destination: subsection.2.1 Item: Title: Quantification of RV Fat Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Baseline Characteristics Destination: subsection.3.1 Item: Title: Comparison between ARVC Patients and Controls Destination: subsection.3.2 Item: Title: Correlates of RV Fat in ARVC Patients Destination: subsection.3.3 Item: Title: Correlates of RV Fat in Controls Destination: subsection.3.4 Item: Title: Ventricular Arrhythmias Destination: subsection.3.5 Item: Title: Discussion Destination: section.4 Children: Item: Title: Fat Quantification for ARVC Diagnosis Destination: subsection.4.1 Item: Title: Fat Distribution in the RV Destination: subsection.4.2 Item: Title: Fat Quantification and Ventricular Arrhythmias Destination: subsection.4.3 Item: Title: Limitations Destination: section.5 Item: Title: Conclusions Destination: section.6 Item: Title: References Destination: appendix.A. Info: Title: Diagnostic and Prognostic Value of Right Ventricular Fat Quantification from Computed Tomography in Arrhythmogenic Right Ventricular Cardiomyopathy Author: Valentina Faga, María Ruiz Cueto, David Viladés Medel, Zoraida Moreno-Weidmann, Paolo D. Dallaglio, Carles Diez Lopez, Gerard Roura, Jose M. Guerra, Rubén Leta Petracca, Joan Antoni Gomez-Hospital, Josep Comin Colet, Ignasi Anguera and Andrea Di Marco Subject: Background: In arrhythmogenic right ventricular cardiomyopathy (ARVC) non-invasive scar evaluation is not included among the diagnostic criteria or the predictors of ventricular arrhythmias (VA) and sudden death (SD). Computed tomography (CT) has excellent spatial resolution and allows a clear distinction between myocardium and fat; thus, it has great potential for the evaluation of myocardial scar in ARVC. Objective: The objective of this study is to evaluate the feasibility, and the diagnostic and prognostic value of semi-automated quantification of right ventricular (RV) fat replacement from CT images. Methods: An observational case control study was carried out including 23 patients with a definite (19) or borderline (4) ARVC diagnosis and 23 age- and sex-matched controls without structural heart disease. All patients underwent contrast-enhanced cardiac CT. RV images were semi-automatically reconstructed with the ADAS-3D software (ADAS3D Medical, Barcelona, Spain). A fibrofatty scar was defined as values of Hounsfield Units (HU) <-10. Within the scar, a border zone (between -10 HU and -50 HU) and dense scar (<-50 HU) were distinguished. Results: All ARVC patients had an RV scar and all scar-related measurements were significantly higher in ARVC cases than in controls (p < 0.001). The total scar area and dense scar area showed no overlapping values between cases and controls, achieving perfect diagnostic performance (sensitivity and specificity of 100%). Among ARVC patients, 16 (70%) had experienced sustained VA or aborted SD. Among all clinical, ECG and imaging parameters, the dense scar area was the only one with a statistically significant association with VA and SD (p = 0.003). Conclusions: In ARVC, RV myocardial fat quantification from CT is feasible and may have considerable diagnostic and prognostic value. Keywords: arrhythmogenic right ventricular cardiomyopathy; cardiac computed tomography;ventricular arrhythmias; sudden death; myocardial fibrofatty replacement Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Jul 10 03:10:42 CEST 2024 ModDate: Wed Jul 10 03:31:44 CEST 2024 ID: 0xf022bb5b8812d9cde40a8e65da101af6, 0xf022bb5b8812d9cde40a8e65da101af6 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: VHATZG+URWPalladioL-Bold FontSubset: true FirstChar: 2 LastChar: 134 FontDescriptor: FontName: VHATZG+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: SOSCBV+CMSY10 FontSubset: true FirstChar: 0 LastChar: 2 FontDescriptor: FontName: SOSCBV+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true ToUnicode: true Font: BaseFont: UZLFPZ+VnURWPalladioL FontSubset: true FirstChar: 129 LastChar: 226 FontDescriptor: FontName: UZLFPZ+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: VTYBOF+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 252 FontDescriptor: FontName: VTYBOF+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: WBVKDJ+URWPalladioL-BoldItal FontSubset: true FirstChar: 112 LastChar: 112 FontDescriptor: FontName: WBVKDJ+URWPalladioL-BoldItal Flags: Symbolic FontBBox: -170, -300, 1073, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: YSPQJI+VnURWPalladioL-Bold FontSubset: true FirstChar: 178 LastChar: 189 FontDescriptor: FontName: YSPQJI+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Font: BaseFont: LZDURF+URWPalladioL-Ital FontSubset: true FirstChar: 2 LastChar: 121 FontDescriptor: FontName: LZDURF+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true ToUnicode: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 115, 280, 152, 289 Annotation: Subtype: Link Rect: 34, 268, 128, 277 Annotation: Subtype: Link Rect: 34, 164, 96, 186 Annotation: Subtype: Link Rect: 125, 90, 154, 99 Annotation: Subtype: Link Rect: 34, 78, 149, 87 Annotation: Subtype: Link Rect: 34, 756, 176, 792 Annotation: Subtype: Link Rect: 515, 756, 560, 792 Annotation: Subtype: Link Rect: 343, 642, 354, 655 Annotation: Subtype: Link Rect: 233, 629, 244, 643 Annotation: Subtype: Link Rect: 423, 629, 434, 643 Annotation: Subtype: Link Rect: 542, 629, 553, 643 Annotation: Subtype: Link Rect: 304, 616, 315, 630 Annotation: Subtype: Link Rect: 523, 616, 534, 630 Annotation: Subtype: Link Rect: 388, 71, 395, 80 ActionDest: 245 Annotation: Subtype: Link Rect: 130, 17, 267, 28 Annotation: Subtype: Link Rect: 424, 17, 560, 28 Annotation: Subtype: Link Rect: 34, 413, 87, 432 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 493, 731, 500, 740 ActionDest: 245 Annotation: Subtype: Link Rect: 347, 693, 354, 702 ActionDest: 245 Annotation: Subtype: Link Rect: 386, 656, 393, 665 ActionDest: 245 Annotation: Subtype: Link Rect: 188, 593, 195, 602 ActionDest: 245 Annotation: Subtype: Link Rect: 341, 568, 348, 577 ActionDest: 245 Annotation: Subtype: Link Rect: 268, 555, 275, 564 ActionDest: 245 Annotation: Subtype: Link Rect: 192, 542, 199, 552 ActionDest: 245 Annotation: Subtype: Link Rect: 202, 542, 214, 552 ActionDest: 245 Annotation: Subtype: Link Rect: 244, 492, 256, 501 ActionDest: 245 Annotation: Subtype: Link Rect: 266, 354, 273, 363 ActionDest: 245 Annotation: Subtype: Link Rect: 414, 266, 426, 275 ActionDest: 245 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 359, 706, 371, 715 ActionDest: 245 Annotation: Subtype: Link Rect: 455, 492, 467, 501 ActionDest: 245 Annotation: Subtype: Link Rect: 298, 427, 424, 439 Annotation: Subtype: Link Rect: 449, 188, 456, 200 ActionDest: 76 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 514, 81, 526, 90 ActionDest: 245 Annotation: Subtype: Link Rect: 433, 68, 445, 77 ActionDest: 245 Annotation: Subtype: Link Rect: 445, 68, 457, 77 ActionDest: 248 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 385, 743, 397, 752 ActionDest: 248 Annotation: Subtype: Link Rect: 319, 691, 326, 703 ActionDest: 105 Annotation: Subtype: Link Rect: 252, 226, 264, 235 ActionDest: 245 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 454, 731, 466, 740 ActionDest: 248 Annotation: Subtype: Link Rect: 552, 541, 559, 551 ActionDest: 134 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 481, 437, 488, 449 ActionDest: 142 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 384, 504, 391, 516 ActionDest: 142 Annotation: Subtype: Link Rect: 431, 504, 438, 516 ActionDest: 105 Annotation: Subtype: Link Rect: 458, 504, 465, 516 ActionDest: 174 Annotation: Subtype: Link Rect: 452, 466, 459, 478 ActionDest: 174 Annotation: Subtype: Link Rect: 413, 429, 420, 441 ActionDest: 203 Page: Sequence: 9 Page: Sequence: 10 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 495, 386, 502, 398 ActionDest: 232 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 360, 318, 372, 328 ActionDest: 248 Annotation: Subtype: Link Rect: 257, 293, 269, 302 ActionDest: 248 Annotation: Subtype: Link Rect: 288, 243, 300, 252 ActionDest: 248 Annotation: Subtype: Link Rect: 424, 231, 436, 240 ActionDest: 245 Annotation: Subtype: Link Rect: 529, 193, 536, 202 ActionDest: 245 Annotation: Subtype: Link Rect: 191, 180, 198, 189 ActionDest: 245 Annotation: Subtype: Link Rect: 257, 168, 269, 177 ActionDest: 248 Annotation: Subtype: Link Rect: 235, 80, 247, 89 ActionDest: 248 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 303, 718, 314, 727 ActionDest: 245 Annotation: Subtype: Link Rect: 337, 681, 349, 690 ActionDest: 245 Annotation: Subtype: Link Rect: 325, 316, 337, 325 ActionDest: 248 Annotation: Subtype: Link Rect: 362, 279, 374, 288 ActionDest: 248 Annotation: Subtype: Link Rect: 192, 216, 204, 225 ActionDest: 248 Annotation: Subtype: Link Rect: 544, 141, 556, 150 ActionDest: 245 Annotation: Subtype: Link Rect: 198, 78, 210, 87 ActionDest: 245 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 294, 681, 306, 690 ActionDest: 248 Annotation: Subtype: Link Rect: 280, 643, 292, 652 ActionDest: 248 Annotation: Subtype: Link Rect: 536, 580, 543, 589 ActionDest: 245 Annotation: Subtype: Link Rect: 544, 580, 556, 589 ActionDest: 248 Annotation: Subtype: Link Rect: 421, 517, 433, 526 ActionDest: 248 Annotation: Subtype: Link Rect: 293, 492, 305, 501 ActionDest: 248 Annotation: Subtype: Link Rect: 536, 189, 560, 200 Annotation: Subtype: Link Rect: 165, 177, 379, 188 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 373, 647, 379, 658 ActionDest: 70 Annotation: Subtype: Link Rect: 535, 629, 541, 640 ActionDest: 70 Annotation: Subtype: Link Rect: 519, 612, 526, 623 ActionDest: 70 Annotation: Subtype: Link Rect: 131, 546, 168, 557 Annotation: Subtype: Link Rect: 175, 546, 211, 557 Annotation: Subtype: Link Rect: 363, 511, 400, 522 Annotation: Subtype: Link Rect: 407, 511, 443, 522 Annotation: Subtype: Link Rect: 345, 488, 383, 499 Annotation: Subtype: Link Rect: 389, 488, 425, 499 Annotation: Subtype: Link Rect: 104, 454, 142, 464 Annotation: Subtype: Link Rect: 148, 454, 184, 464 Annotation: Subtype: Link Rect: 508, 430, 544, 441 Annotation: Subtype: Link Rect: 180, 397, 217, 407 Annotation: Subtype: Link Rect: 223, 397, 259, 407 Annotation: Subtype: Link Rect: 129, 362, 167, 372 Annotation: Subtype: Link Rect: 173, 362, 209, 372 Annotation: Subtype: Link Rect: 59, 316, 96, 326 Annotation: Subtype: Link Rect: 413, 281, 450, 292 Annotation: Subtype: Link Rect: 59, 247, 96, 257 Annotation: Subtype: Link Rect: 289, 212, 327, 223 Annotation: Subtype: Link Rect: 333, 212, 369, 223 Annotation: Subtype: Link Rect: 455, 177, 493, 188 Annotation: Subtype: Link Rect: 499, 177, 535, 188 Annotation: Subtype: Link Rect: 357, 131, 393, 142 Annotation: Subtype: Link Rect: 166, 109, 202, 119 Annotation: Subtype: Link Rect: 285, 74, 322, 85 Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 175, 718, 213, 729 Annotation: Subtype: Link Rect: 219, 718, 255, 729 Annotation: Subtype: Link Rect: 397, 706, 435, 718 Annotation: Subtype: Link Rect: 441, 706, 477, 718 Annotation: Subtype: Link Rect: 280, 683, 317, 694 Annotation: Subtype: Link Rect: 324, 683, 360, 694 Annotation: Subtype: Link Rect: 512, 672, 550, 683 Annotation: Subtype: Link Rect: 159, 649, 197, 660 Annotation: Subtype: Link Rect: 244, 614, 281, 625 Annotation: Subtype: Link Rect: 288, 614, 324, 625 Annotation: Subtype: Link Rect: 447, 580, 484, 591 Annotation: Subtype: Link Rect: 491, 580, 527, 591 Annotation: Subtype: Link Rect: 268, 545, 306, 556 Annotation: Subtype: Link Rect: 312, 545, 348, 556 Annotation: Subtype: Link Rect: 362, 522, 400, 533 Annotation: Subtype: Link Rect: 406, 522, 442, 533 Annotation: Subtype: Link Rect: 451, 488, 488, 499 Annotation: Subtype: Link Rect: 290, 453, 327, 464 Annotation: Subtype: Link Rect: 340, 419, 378, 430 Checksum: a967db07 Type: CRC32 Checksum: 1b7f613b271c69840f26c191c0390c39 Type: MD5 Checksum: e054fb76f01e2adac48b026bebd3f7e0964ce13b Type: SHA-1 Checksum: fb34712de8eb72d6eda866096ddf3ba47563a2cb2e9579ee66a9e7e393c3cdee Type: SHA-256