Open Access

Right heart strain in arrhythmogenic right ventricular cardiomyopathy: implications for cardiovascular outcome

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Date: 29 April 2024
Journal: European Heart Journal - Cardiovascular Imaging , Volume 25 , Issue 8 , Pages 1061 - 1068
Topic: ARRHYTHMIAS AND DEVICE THERAPY, Arrhythmias, General, HEART FAILURE, Acute Heart Failure, Chronic Heart Failure, IMAGING, Echocardiography, VALVULAR, MYOCARDIAL, PERICARDIAL, PULMONARY, CONGENITAL HEART DISEASE, Myocardial Disease, Syncope and Bradycardia
Authors: S. Anwer , L. Stollenwerk , N. Winkler , F. Guastafierro , M. Hebeisen , D. Akdis , A. Saguner , C. Brunckhorst , F. Duru , F. Tanner

ESC Journals

AbstractAims

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive myocardial dysfunction and associated with an increased risk of major cardiovascular (CV) events. To determine right heart strain (ventricular and atrial global longitudinal strain (RVGLS and RAGLS) in patients with definite ARVC and its association with adverse events during follow-up.

Methods and results

RVGLS and RAGLS were analysed in focused right heart apical views from 70 patients using TomTec ImageArena and association with a composite endpoint was determined (sustained ventricular arrhythmia and cardiovascular death). Over a median follow-up duration of 4.9 years, 26 (37%) patients met the endpoint. RVGLS was significantly impaired in the event group (−11.5 [−13.3 to −10.2] %) vs. the no-event group (−15.8 [−17.1 to −14.5] %, P < 0.001), and so was RAGLS (22.8 [21.4–27.4] % vs. 31.5 [25.1–39.6] %, respectively, P < 0.001). In Cox regression, RVGLS (HR 1.36, P < 0.001) and RAGLS (HR 0.92, P = 0.002) were associated with a higher risk of adverse events. In multivariable Cox regression models, RVGLS and RAGLS remained independent of and were incremental to age, gender, and conventional RV parameters, and model fitness was improved when RVGLS and RAGLS were applied together rather than alone.

Conclusion

RVGLS and RAGLS are more impaired in patients with adverse events and associated with adverse events independent of age, gender, and conventional RV parameters. When RVGLS and RAGLS are applied together, prediction models are improved suggesting that right heart strain may form part of the echocardiographic routine protocol in patients with ARVC.

About the contributors

Shehab Anwer

Role: Author

Lauren Stollenwerk

Role: Author

Neria E Winkler

Role: Author