Cardiac magnetic resonance imaging in arrhythmogenic right ventricular cardiomyopathy: correlation to the QRS dispersion

The aim of the study was to evaluate the relationship between the presence of right ventricular abnormalities detected by cardiac magnetic resonance (CMR) and QRS dispersion, the strongest independent predictor of sudden death in ARVC. A consecutive series of 40 patients from a single institution were recruited with a clinical diagnosis of ARVC based on the diagnostic criteria. All patients underwent systematic clinical evaluation, including history and examination, electrocardiography, 24-h Holter monitor, chest radiography, echocardiography and CMR examination and were divided into two groups according to the QRS dispersion: group I, QRS dispersion ≥ 40 ms; group II, QRS dispersion < 40 ms. The relationship between the characteristic parameters of CMR image and QRS dispersion were analyzed in two groups. There were significant differences in QRS dispersion (57±14 ms vs. 26±11 ms), right ventricular end-diastolic diameter (57±10 mm vs. 48±11 mm, P=.012), right ventricular end-systolic diameter (52±10 mm vs. 44±11 mm, P=.010), right ventricular end-diastolic volume (260±105 ml vs. 180±66 ml, P=.006), right ventricular end-systolic volume (222±98 ml vs. 148±61 ml, P=.006) and myocardial fibrosis detection rate (74% vs. 38%, P=.024) between two groups. For all patients with ARVC, QRS dispersion and right ventricular end-diastolic volume (r= 0.66, P<.001), right ventricular end-systolic volume (r= 0.67, P<.001), right ventricular outflow tract area (r= 0.68, P<.001) showed a moderate positive correlation. Right ventricular outflow tract area, right ventricular end-diastolic volume and end-systolic volume detected by CMR in patients with ARVC were positively correlated to the extent of QRS dispersion (≥ 40 ms), the strongest independent predictor of sudden cardiac death.