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CC BY-NC-ND 4.0 · Indographics 2025; 04(02): 43-49
DOI: 10.1055/s-0045-1814085
Pictorial Review

A Pictorial Review of the 2020 Padua Criteria in Diagnosing Arrhythmogenic Cardiomyopathy with Insights from Native T1 Mapping

Authors

  • Thiagarajan Veerappan 

    1   Barnard Institute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India

  • Babu Peter Sathyanathan

    1   Barnard Institute of Radiology, Madras Medical College, Chennai, Tamil Nadu, India

Funding None.
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Abstract

Arrhythmogenic cardiomyopathy (ACM) is a heritable myocardial disorder characterized by progressive fibrofatty replacement, typically involving the right and/or left ventricles. The 2020 Padua Criteria offer an updated, multiparametric diagnostic framework that addresses the limitations of the 2010 Task Force Criteria. Cardiac magnetic resonance (CMR), particularly native T1 mapping, has emerged as a pivotal modality for myocardial tissue characterization in ACM. This prospective study evaluated four patients with clinically suspected ACM and 12 age-matched healthy controls. All participants underwent comprehensive CMR at 3.0 Tesla, including cine imaging, late gadolinium enhancement (LGE), and native/postcontrast T1 mapping. The Padua Criteria were applied for diagnostic classification and phenotypic characterization. Quantitative T1 mapping was employed to assess myocardial fibrosis. Application of the Padua Criteria yielded diagnoses of right-dominant ACM (n = 1), biventricular ACM (n = 2), and a borderline case (n = 1). Native T1 values were significantly elevated in the right ventricular free wall among ACM patients compared with controls (mean 1462.25 vs. 1245.51 ms, p < 0.0001). Notably, native T1 mapping identified diffuse myocardial abnormalities in cases lacking LGE. The Padua Criteria facilitates accurate phenotypic classification of ACM. Native T1 mapping enhances diagnostic sensitivity, particularly in early or subtle disease, and represents a promising noninvasive biomarker of myocardial fibrosis. Further validation in larger cohorts is warranted.

Keywords

arrhythmogenic cardiomyopathy - cardiac magnetic resonance (CMR) - late gadolinium enhancement (LGE) - native T1 mapping - Padua Criteria - right ventricular dysfunction

Note

The manuscript was earlier presented by Dr. Thiagarajan Veerappan as part of poster presentation in AOCR 2025 at Chennai on January 24, 2025. Abstract ID – ABS0288.


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Publication History

Article published online:
09 December 2025

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