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Minerva Medica 2020 Jul 22

DOI: 10.23736/S0026-4806.20.06782-8


lingua: Inglese

Differential diagnosis of arrhythmogenic cardiomyopathy: phenocopies vs disease variants

Alberto CIPRIANI 1, Martina PERAZZOLO MARRA 1, Riccardo BARIANI 1, Giulia MATTESI 1, Riccardo VIO 1, Natascia BETTELLA 1, Manuel DE LAZZARI 1, Raffaella MOTTA 2, Barbara BAUCE 1, Alessandro ZORZI 1, Domenico CORRADO 1

1 Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy; 2 Radiology Unit, Department of Medicine, University of Padua Medical School, Padua, Italy


Arrhythmogenic cardiomyopathy (ACM) is a genetic heart muscle disease caused by mutations of desmosomal genes in about 50% of patients. Affected patients may have defective nondesmosomal genes. The ACM phenotype may occur in other genetic cardiomyopathies, cardiocutaneous syndromes or neuromuscular disorders. A sizeable proportion of patients have nongenetic diseases with clinical features resembling ACM (phenocopies). The identification of biventricular and left-dominant phenotypic variants has made differential diagnosis more difficult because of the broader spectrum of phenocopies which require a detailed clinical study with appropriate evaluation of most prominent and discriminatory disease features. Conditions that enter into differential diagnosis of ACM include heart muscle diseases affecting the right ventricle, the left ventricle, or both. To confirm a conclusive diagnosis of ACM, these differential possibilities need to be reasonably excluded by an accurate and targeted clinical evaluation. This article reviews the clinical and imaging features of major phenocopies of ACM and provides indications for differential diagnosis. The recent etiologic classification of Arrhythmogenic Cardiomyopathies, whose common denominator is the distinctive phenotype characterized by a hypokinetic and nondilated ventricle with a large amount of myocardial fibrosis underlying its propensity to generate ventricular arrhythmias is also addressed.

KEY WORDS: Arrhythmogenic right ventricular dysplasia; Cardiomyopathies; Magnetic Resonance Imaging

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