The diagnostic value of right heart strain on cardiac MRI for detecting subclinical arrhythmogenic right ventricular cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) predominantly affects the right heart, but conventional Cardiac MRI (CMR) parameters often overlook subclinical ARVC with preserved right ventricular (RV) function. This study evaluates the diagnostic value of RV and right atrial (RA) strain in subclinical ARVC patients.

In this single-center retrospective study, 123 participants were enrolled, including 41 patients with subclinical ARVC (mean age 39±16 years, 25 men), 41 patients with impaired ARVC (mean age 40±17 years, 27 men), and 41 healthy controls (mean age 39±11 years, 25 men) between January 2010 and October 2020. Right ventricular and right atrial strain parameters were obtained using CMR FT. Univariate and stepwise multivariate binary logistic regression analyses were conducted to identify CMR-derived independent predictors of subclinical ARVC. Incremental diagnostic value was assessed using C indices.

RA and RV strain, along with conventional CMR parameters, were assessed in 41 definite subclinical ARVC patients with preserved RV function, compared to 41 definite impaired ARVC patients with RV dysfunction and 41 healthy controls. RA reservoir strain, conduit strain, and RV global longitudinal strain (RVGLS) were significantly reduced in the subclinical ARVC group compared to controls. Receiver operating characteristic analysis revealed that RVGLS > -19% [area under the curve (AUC): 0.85] and RA conduit strain < 17% (AUC: 0.80) outperformed other CMR conventional parameters in diagnosing subclinical ARVC. Multivariable logistic regression identified RVGLS [odds ratio (OR): 1.39, P < 0.01] and RA conduit strain (OR: 0.87, P < 0.01) as independent predictors of subclinical ARVC diagnosis. RA conduit strain was significantly negatively correlated with N-terminal pro brain natriuretic peptide (NT-proBNP) levels (r = -0.44, P < 0.01). Combined evaluation of RVGLS and RA conduit strain significantly improved diagnostic accuracy based on CMR-derived structural and volumetric parameters.

RVGLS and RA conduit strain are sensitive markers for early detection of subclinical ARVC, outperforming conventional CMR parameters, with their combined evaluation further improving diagnostic accuracy.

Graphic abstract