2079 Late gadolinium enhancement of the right ventricle – a substrate of different pathologies in contrast-enhanced cardiac MRI

Abstract Funding Acknowledgements none Background Electroanatomical map (EAM) detects areas of low voltage as a surrogated marker of fibrosis areas, being the reference technique for its detection. Cardiac magnetic resonance with Late Gadolinium enhancement (CMR-LGE) allows non-invasive detection of atrial fibrotic areas. CMR-LGE studies have focused on the left atrium since now. Purpose We need to validate this test to extend its use to the right atrium (RA), since it is involved in the arrhythmogenic substrate of several arrhythmias, and probably also in atrial fibrillation (AF). Methods Prospective observational study. Fifteen patients undergoing a first AF ablation procedure were included. All patients had a pre-procedural LGE-CMR performed. The blood pool-normalized intensity signal (image intensity ratio-IIR) was calculated for the right atrial wall, and values projected in a shell. IIR values validated for the left atrium were used to identify dense and intermediate fibrosis, and healthy tissue (>1.32, 1.2-1.32, <1.2, respectively). During the procedure but before ablation, a point-by-point high density EA bipolar voltage map of RA was obtained with a multipolar catheter. Standard voltage thresholds of 0,1 mV and 0,5 mV were used to characterize fibrotic and healthy tissue in EAM. For each RA, the EAM was projected into the IIR shell, and the correlation between bipolar voltage and normalized IIR values for each shell point was quantified. Then, we also obtained its concordance (categorical variables) according to the label automatically assigned by EAM/CMR with the pre-set thresholds: healthy tissue/ intermediate fibrosis/dense fibrosis. Results A total of 8,830 points were obtained, mean per patient 588 (± 509) points. A global weak negative correlation was found between the EA bipolar voltage map (EAM) and IIR (CMR) (r= -0.16, p < 0.0001)(figure). LGE-CMR identified more healthy tissue than EAM (81.0% vs 60.6% respectively), then CMR underestimated the fibrotic tissue in RA. Finally, we analyzed the concordance and we obtained that the degree of accuracy between both measurements was 55.7%. Conclusion There was an inverse correlation between the bipolar voltage EAM and IIR (CMR) of low grade but with statistical significance. CMR underestimated fibrotic tissue in RA with respect to its identification by EAM. Abstract Figure. Correlation between bipolar voltage-IIR

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479 When 2 rights make a wrong

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.257 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

J Tong ◽

P Joseph Francis ◽

E Lee

Keyword(s):

Right Ventricle ◽

Tricuspid Valve ◽

Cardiac Mri ◽

Right Atrium ◽

Cardiac Myxoma ◽

Left Ventricular Ejection ◽

Definitive Treatment ◽

Transthoracic Echocardiogram ◽

First Case ◽

The Right

Abstract Background The presence of an intra-cardiac mass is always a cause for concern, with regards to not only aetiology, but also treatment of complications. We describe a case series of 2 right sided cardiac myxomas, where the first case described an unusual location for tumour occurrence, while the second case provided insights into complications of a cardiac myxoma. Methods The first case involved a 70 year old asymptomatic lady who was referred for an additional heart sound. A transthoracic echocardiogram (TTE) showed a large, mobile 1.5 X 1.2 cm mass, attached to the atrial surface of septal tricuspid valve leaflet, prolapsing in and out of the right sided chambers. This was confirmed on transoesophageal echocardiogram (TEE). Cardiac MRI (magnetic resonance imaging) showed a similar mass attached to the septal tricuspid leaflet with features consistent with a myxoma. She was referred to cardiothoracic surgery, and 2 lobulated tumours arising the septal tricuspid valve and adjacent posterior leaflet were seen. The tumours were resected and a bio-prosthetic tricuspid valve replacement implanted. Histology of the tumours showed myxomatous degeneration of tricuspid valve, consistent with cardiac myxoma. The second case was a 56 year old lady who had dyspnoea, pedal oedema and an elevated jugular venous pulse on examination. A TTE done showed a large 7 X 4 cm mass extending from the right atrium (RA) into the right ventricle (RV). The left ventricular ejection fraction was 35%. Cardiac MRI confirmed the presence of a large mass in the right ventricle that exerted pressure effects on the ventricular septum and RV anterior free wall. Intra-operatively, a large RA mass attached by a stalk to the fossa ovalis was seen. The mass was excised and histology was consistent with cardiac myxoma. A repeat transthoracic echocardiogram done 2 weeks later showed normalisation of the LVEF. See images below for more information. Conclusion While myxomas are the most common benign cardiac tumours, they occur less commonly in the right atrium, and much less so on the tricuspid valve. Clinical manifestations range from being completely asymptomatic, as in the 1st case, to non-specific constitutional symptoms such as fever or general malaise, and to life-threatening complications. These include embolism to the pulmonary circulation, causing sudden death, or to the systemic circulation through an intra-cardiac shunt, causing strokes. This risk is increased if the tumour is large, polypoidal and friable. Large tumours can also cause obstructive symptoms and heart failure. Thus timely diagnosis with multi-modality imaging tools, and definitive treatment with complete resection of the tumour are essential. Continued monitoring for recurrences of the tumour, which can occur in 1-5% of all cases, should be performed as well. Abstract 479 Figure. Right sided cardiac masses

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