The value of genetic testing in the diagnosis and risk stratification of arrhythmogenic right ventricular cardiomyopathy

Netherlands ACM Registry; Remco de Brouwer; Laurens P Bosman; Sophia Gripenstedt; Arthur A M Wilde; Maarten P van den Berg; J Peter van Tintelen; Rudolf A de Boer; Anneline S J M Te Riele

doi:10.1016/j.hrthm.2022.05.038

The value of genetic testing in the diagnosis and risk stratification of arrhythmogenic right ventricular cardiomyopathy

Netherlands ACM Registry, Remco de Brouwer^*, Laurens P Bosman, Sophia Gripenstedt, Arthur A M Wilde, Maarten P van den Berg, J Peter van Tintelen, Rudolf A de Boer, Anneline S J M Te Riele

^*Corresponding author for this work

Cardiovascular Centre (CVC)

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by risk of malignant ventricular arrhythmias (VA). ARVC is diagnosed using an array of clinical tests in the consensus-based task force criteria (TFC), one of which is genetic testing.

OBJECTIVE: To investigate the value of genetic testing in diagnosing ARVC and its relation to the occurrence of first malignant VA.

METHODS: A multicenter cohort of ARVC patients was scored using the revised 2010 TFC with and without genetic criterion, analyzing any resulting loss or delay of diagnosis. Malignant VA was defined as sustained ventricular arrhythmia (≥30s duration at ≥100 bpm or requiring intervention).

RESULTS: We included 402 subjects (55% male, 54% proband, 40 [27-51] years old at presentation) who were diagnosed with definite ARVC. A total of 232 (58%) subjects fulfilled genetic testing criteria. Removing the genetic criterion caused loss of diagnosis in 18 (4%) patients (11/216 [5%] probands, 7/186 [4%] relatives), and delay of diagnosis ≥30 days in 22 (5%) patients (21/216 [10%] probands, 1/186 [0.5%] relative). A first malignant VA occurred in no patients who lost diagnosis and in 3 patients (3/216 [1%] probands and no relatives) during their diagnosis delay, none fatal. Time to event analysis showed no significant difference in time from diagnosis to malignant VA between pathogenic variant carriers and non-carriers.

CONCLUSION: Disregarding the genetic criterion of the TFC caused loss or delay of diagnosis in 10% (n=40/402) of ARVC patients. Malignant VA occurred in 1% (n=3/402) of cases with lost or delayed diagnosis, none fatal.

Original language	English
Pages (from-to)	1659-1665
Number of pages	7
Journal	Heart Rhythm
Volume	19
Issue number	10
Early online date	7-Jun-2022
DOIs	https://doi.org/10.1016/j.hrthm.2022.05.038
Publication status	Published - Oct-2022

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Netherlands ACM Registry, de Brouwer, R., Bosman, L. P., Gripenstedt, S., Wilde, A. A. M., van den Berg, M. P., van Tintelen, J. P., de Boer, R. A., & Te Riele, A. S. J. M. (2022). The value of genetic testing in the diagnosis and risk stratification of arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm, 19(10), 1659-1665. https://doi.org/10.1016/j.hrthm.2022.05.038

@article{de88b16cb9e04d2a88fe94d63d675ff6,

title = "The value of genetic testing in the diagnosis and risk stratification of arrhythmogenic right ventricular cardiomyopathy",

abstract = "BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by risk of malignant ventricular arrhythmias (VA). ARVC is diagnosed using an array of clinical tests in the consensus-based task force criteria (TFC), one of which is genetic testing.OBJECTIVE: To investigate the value of genetic testing in diagnosing ARVC and its relation to the occurrence of first malignant VA.METHODS: A multicenter cohort of ARVC patients was scored using the revised 2010 TFC with and without genetic criterion, analyzing any resulting loss or delay of diagnosis. Malignant VA was defined as sustained ventricular arrhythmia (≥30s duration at ≥100 bpm or requiring intervention).RESULTS: We included 402 subjects (55% male, 54% proband, 40 [27-51] years old at presentation) who were diagnosed with definite ARVC. A total of 232 (58%) subjects fulfilled genetic testing criteria. Removing the genetic criterion caused loss of diagnosis in 18 (4%) patients (11/216 [5%] probands, 7/186 [4%] relatives), and delay of diagnosis ≥30 days in 22 (5%) patients (21/216 [10%] probands, 1/186 [0.5%] relative). A first malignant VA occurred in no patients who lost diagnosis and in 3 patients (3/216 [1%] probands and no relatives) during their diagnosis delay, none fatal. Time to event analysis showed no significant difference in time from diagnosis to malignant VA between pathogenic variant carriers and non-carriers.CONCLUSION: Disregarding the genetic criterion of the TFC caused loss or delay of diagnosis in 10% (n=40/402) of ARVC patients. Malignant VA occurred in 1% (n=3/402) of cases with lost or delayed diagnosis, none fatal.",

author = "{Netherlands ACM Registry} and {de Brouwer}, Remco and Bosman, {Laurens P} and Sophia Gripenstedt and Wilde, {Arthur A M} and {van den Berg}, {Maarten P} and {van Tintelen}, {J Peter} and {de Boer}, {Rudolf A} and {Te Riele}, {Anneline S J M}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Inc.",

year = "2022",

month = oct,

doi = "10.1016/j.hrthm.2022.05.038",

language = "English",

volume = "19",

pages = "1659--1665",

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TY - JOUR

T1 - The value of genetic testing in the diagnosis and risk stratification of arrhythmogenic right ventricular cardiomyopathy

AU - Netherlands ACM Registry

AU - de Brouwer, Remco

AU - Bosman, Laurens P

AU - Gripenstedt, Sophia

AU - Wilde, Arthur A M

AU - van den Berg, Maarten P

AU - van Tintelen, J Peter

AU - de Boer, Rudolf A

AU - Te Riele, Anneline S J M

PY - 2022/10

Y1 - 2022/10

N2 - BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by risk of malignant ventricular arrhythmias (VA). ARVC is diagnosed using an array of clinical tests in the consensus-based task force criteria (TFC), one of which is genetic testing.OBJECTIVE: To investigate the value of genetic testing in diagnosing ARVC and its relation to the occurrence of first malignant VA.METHODS: A multicenter cohort of ARVC patients was scored using the revised 2010 TFC with and without genetic criterion, analyzing any resulting loss or delay of diagnosis. Malignant VA was defined as sustained ventricular arrhythmia (≥30s duration at ≥100 bpm or requiring intervention).RESULTS: We included 402 subjects (55% male, 54% proband, 40 [27-51] years old at presentation) who were diagnosed with definite ARVC. A total of 232 (58%) subjects fulfilled genetic testing criteria. Removing the genetic criterion caused loss of diagnosis in 18 (4%) patients (11/216 [5%] probands, 7/186 [4%] relatives), and delay of diagnosis ≥30 days in 22 (5%) patients (21/216 [10%] probands, 1/186 [0.5%] relative). A first malignant VA occurred in no patients who lost diagnosis and in 3 patients (3/216 [1%] probands and no relatives) during their diagnosis delay, none fatal. Time to event analysis showed no significant difference in time from diagnosis to malignant VA between pathogenic variant carriers and non-carriers.CONCLUSION: Disregarding the genetic criterion of the TFC caused loss or delay of diagnosis in 10% (n=40/402) of ARVC patients. Malignant VA occurred in 1% (n=3/402) of cases with lost or delayed diagnosis, none fatal.

AB - BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by risk of malignant ventricular arrhythmias (VA). ARVC is diagnosed using an array of clinical tests in the consensus-based task force criteria (TFC), one of which is genetic testing.OBJECTIVE: To investigate the value of genetic testing in diagnosing ARVC and its relation to the occurrence of first malignant VA.METHODS: A multicenter cohort of ARVC patients was scored using the revised 2010 TFC with and without genetic criterion, analyzing any resulting loss or delay of diagnosis. Malignant VA was defined as sustained ventricular arrhythmia (≥30s duration at ≥100 bpm or requiring intervention).RESULTS: We included 402 subjects (55% male, 54% proband, 40 [27-51] years old at presentation) who were diagnosed with definite ARVC. A total of 232 (58%) subjects fulfilled genetic testing criteria. Removing the genetic criterion caused loss of diagnosis in 18 (4%) patients (11/216 [5%] probands, 7/186 [4%] relatives), and delay of diagnosis ≥30 days in 22 (5%) patients (21/216 [10%] probands, 1/186 [0.5%] relative). A first malignant VA occurred in no patients who lost diagnosis and in 3 patients (3/216 [1%] probands and no relatives) during their diagnosis delay, none fatal. Time to event analysis showed no significant difference in time from diagnosis to malignant VA between pathogenic variant carriers and non-carriers.CONCLUSION: Disregarding the genetic criterion of the TFC caused loss or delay of diagnosis in 10% (n=40/402) of ARVC patients. Malignant VA occurred in 1% (n=3/402) of cases with lost or delayed diagnosis, none fatal.

U2 - 10.1016/j.hrthm.2022.05.038

DO - 10.1016/j.hrthm.2022.05.038

M3 - Article

C2 - 35688345

SN - 1547-5271

VL - 19

SP - 1659

EP - 1665

JO - Heart Rhythm

JF - Heart Rhythm

IS - 10

ER -

The value of genetic testing in the diagnosis and risk stratification of arrhythmogenic right ventricular cardiomyopathy

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