Seth J. Berkowitz

Prevalence of left ventricular regional dysfunction in arrhythmogenic right ventricular dysplasia: A tagged MRI study

Background—Although arrhythmogenic right ventricular dysplasia (ARVD) predominantly affects the right ventricle (RV), genetic/molecular and histological changes are biventricular. Regional left ventricular (LV) function has not been systematically studied in ARVD. Methods and Results—The study population included 21 patients with suspected ARVD who underwent evaluation with MRI including tagging. Eleven healthy volunteers served as control subjects. Peak systolic regional circumferential strain (Ecc, %) was calculated by harmonic phase from tagged MRI based on the 16-segment model. Patients who met ARVD Task Force criteria were classified as definite ARVD, whereas patients with a positive family history who had 1 additional minor criterion and patients without a family history with 1 major or 2 minor criteria were classified as probable ARVD. Of the 21 ARVD subjects, 11 had definite ARVD and 10 had probable ARVD. Compared with control subjects, probable ARVD patients had similar RV ejection fraction (58.9±6.2% versus 53.5±7.6%, P=0.20), but definite ARVD patients had significantly reduced RV ejection fraction (58.9±6.2% versus 45.2±6.0%, P=0.001). LV ejection fraction was similar in all 3 groups. Compared with control subjects, peak systolic Ecc was significantly less negative in 6 of 16 (37.5%) segments in definite ARVD and 3 of 16 segments (18.7%) in probable ARVD (all P<0.05). Conclusions—ARVD is associated with regional LV dysfunction, which appears to parallel degree of RV dysfunction. Further large studies are needed to validate this finding and to better define implications of subclinical segmental LV dysfunction.

High prevalence of Left Ventricular Regional Dysfunction in Arrhythmogenic Right Ventricular Dysplasia: a tagged MRI study

Background—Although arrhythmogenic right ventricular dysplasia (ARVD) predominantly affects the right ventricle (RV), genetic/molecular and histological changes are biventricular. Regional left ventricular (LV) function has not been systematically studied in ARVD. Methods and Results—The study population included 21 patients with suspected ARVD who underwent evaluation with MRI including tagging. Eleven healthy volunteers served as control subjects. Peak systolic regional circumferential strain (Ecc, %) was calculated by harmonic phase from tagged MRI based on the 16-segment model. Patients who met ARVD Task Force criteria were classified as definite ARVD, whereas patients with a positive family history who had 1 additional minor criterion and patients without a family history with 1 major or 2 minor criteria were classified as probable ARVD. Of the 21 ARVD subjects, 11 had definite ARVD and 10 had probable ARVD. Compared with control subjects, probable ARVD patients had similar RV ejection fraction (58.9±6.2% versus 53.5±7.6%, P=0.20), but definite ARVD patients had significantly reduced RV ejection fraction (58.9±6.2% versus 45.2±6.0%, P=0.001). LV ejection fraction was similar in all 3 groups. Compared with control subjects, peak systolic Ecc was significantly less negative in 6 of 16 (37.5%) segments in definite ARVD and 3 of 16 segments (18.7%) in probable ARVD (all P<0.05). Conclusions—ARVD is associated with regional LV dysfunction, which appears to parallel degree of RV dysfunction. Further large studies are needed to validate this finding and to better define implications of subclinical segmental LV dysfunction.

Resident Idea System: A Novel Tool to Engage Trainees in Quality Improvement at the Institutional Level

DESCRIPTION OF THE PROBLEM With the recent introduction of the new accreditation system for graduate medical education, the integration of trainees into institutional efforts related to patient safety and quality improvement has become important. As part of the Clinical Learning Environment Review process, site visitors specifically focus on how institutions are engaging trainees in these initiatives [1,2]. Recently, many departments have developed didactic curricula in quality improvement and safety [3-6]. Multiple studies have demonstrated the value of involving trainees in quality improvement [7-10]. Trainees are often on the front lines in academic departments and thus are a great resource for ideas regarding system improvements. However, trainee involvement in quality improvement is not universal, and trainee ideas often go unheard because of the lack of a structured means of communication with administrators.

Fatal Hemoptysis After Closure of Gastrobronchial Fistula Using an Amplatzer Vascular Device

The Amplatzer family of vascular devices has been used off-label for the treatment of complex gastrointestinal and airway fistulas. We report a case in which closure of a benign gastrobronchial fistula with the use of an Amplatzer device resulted in massive hemoptysis and death.

Prevalence of Left Ventricular Regional Dysfunction in Arrhythmogenic Right Ventricular DysplasiaCLINICAL PERSPECTIVE: A Tagged MRI Study

Background—Although arrhythmogenic right ventricular dysplasia (ARVD) predominantly affects the right ventricle (RV), genetic/molecular and histological changes are biventricular. Regional left ventricular (LV) function has not been systematically studied in ARVD. Methods and Results—The study population included 21 patients with suspected ARVD who underwent evaluation with MRI including tagging. Eleven healthy volunteers served as control subjects. Peak systolic regional circumferential strain (Ecc, %) was calculated by harmonic phase from tagged MRI based on the 16-segment model. Patients who met ARVD Task Force criteria were classified as definite ARVD, whereas patients with a positive family history who had 1 additional minor criterion and patients without a family history with 1 major or 2 minor criteria were classified as probable ARVD. Of the 21 ARVD subjects, 11 had definite ARVD and 10 had probable ARVD. Compared with control subjects, probable ARVD patients had similar RV ejection fraction (58.9±6.2% versus 53.5±7.6%, P=0.20), but definite ARVD patients had significantly reduced RV ejection fraction (58.9±6.2% versus 45.2±6.0%, P=0.001). LV ejection fraction was similar in all 3 groups. Compared with control subjects, peak systolic Ecc was significantly less negative in 6 of 16 (37.5%) segments in definite ARVD and 3 of 16 segments (18.7%) in probable ARVD (all P<0.05). Conclusions—ARVD is associated with regional LV dysfunction, which appears to parallel degree of RV dysfunction. Further large studies are needed to validate this finding and to better define implications of subclinical segmental LV dysfunction.

Prevalence of Left Ventricular Regional Dysfunction in Arrhythmogenic Right Ventricular DysplasiaCLINICAL PERSPECTIVE

Background—Although arrhythmogenic right ventricular dysplasia (ARVD) predominantly affects the right ventricle (RV), genetic/molecular and histological changes are biventricular. Regional left ventricular (LV) function has not been systematically studied in ARVD. Methods and Results—The study population included 21 patients with suspected ARVD who underwent evaluation with MRI including tagging. Eleven healthy volunteers served as control subjects. Peak systolic regional circumferential strain (Ecc, %) was calculated by harmonic phase from tagged MRI based on the 16-segment model. Patients who met ARVD Task Force criteria were classified as definite ARVD, whereas patients with a positive family history who had 1 additional minor criterion and patients without a family history with 1 major or 2 minor criteria were classified as probable ARVD. Of the 21 ARVD subjects, 11 had definite ARVD and 10 had probable ARVD. Compared with control subjects, probable ARVD patients had similar RV ejection fraction (58.9±6.2% versus 53.5±7.6%, P=0.20), but definite ARVD patients had significantly reduced RV ejection fraction (58.9±6.2% versus 45.2±6.0%, P=0.001). LV ejection fraction was similar in all 3 groups. Compared with control subjects, peak systolic Ecc was significantly less negative in 6 of 16 (37.5%) segments in definite ARVD and 3 of 16 segments (18.7%) in probable ARVD (all P<0.05). Conclusions—ARVD is associated with regional LV dysfunction, which appears to parallel degree of RV dysfunction. Further large studies are needed to validate this finding and to better define implications of subclinical segmental LV dysfunction.