A1 Refereed original research article in a scientific journal
Arrhythmogenic Right Ventricular Cardiomyopathy: The Importance of Biventricular Strain in Risk-Stratification
Authors: Chua, Aileen Paula; Laenens, Dorien; Sarrazyn, Camille; Lopez-Santi, Maria Pilar; Nabeta, Takeru; Myagmardorj, Rinchyenkhand; Bootsma, Marianne; Barge-Schaapveld, Daniela Q.C.M.; Bax, Jeroen J.; Marsan, Nina Ajmone
Publisher: Elsevier
Publication year: 2025
Journal: American Journal of Cardiology
Journal name in source: The American Journal of Cardiology
Volume: 241
First page : 61
Last page: 68
ISSN: 0002-9149
eISSN: 1879-1913
DOI: https://doi.org/10.1016/j.amjcard.2025.01.006
Web address : https://doi.org/10.1016/j.amjcard.2025.01.006
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/485048102
Despite arrhythmogenic right ventricular cardiomyopathy (ARVC) being predominantly a right ventricular (RV) disease, concomitant left ventricular (LV) involvement has been recognized. ARVC is diagnosed by the RV-centric 2010 Task Force Criteria(TFC) using routine echocardiography, but previous studies have suggested that strain imaging may be more sensitive to detect RV and LV dysfunction. No data however are available regarding the additional value of combining biventricular strain for risk stratification. This study aims to assess the prognostic value of both LV global longitudinal strain (GLS) and RV free wall strain (FWLS) in patients with ARVC. To accomplish this, 204 patients who met the TFC for the ARVC spectrum were included. Patients (age 41 § 17 years,55% men) were divided into impaired(n = 33), discordant (RV or LV impaired, n = 70), and normal (n = 101) strain groups based on a value of ≥18% for both ventricles. During a follow-up of 87 [24−136] months, 57 (28%) experienced the composite outcome of all-cause mortality, arrhythmic events, implantable cardioverter defibrillator therapy and heart failure events, and a significant difference in event-free survival was observed (p <0.001) between the 3 groups. In the multivariable analysis, the strain groups remained associated with outcomes (p = 0.014) after adjusting for age, sex, history of syncope and definite ARVC diagnosis. A subanalysis including only definite and borderline diagnosed ARVC confirmed that the strain groups were independently predictive of the endpoint (p = 0.023). In conclusion, biventricular involvement by strain analysis may help risk stratification in ARVC patients, with the worst outcomes of patients with both RV and LV impaired strain.
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Funding information in the publication:
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:
J.J.B. reports financial support was provided by Pie Medical Imaging BV. N.A.M. reports a relationship with Abbott Vascular Inc that includes: speaking and lecture fees. N.A.M. reports a relationship with Philips Ultrasound, Inc. that includes: speaking and lecture fees. N.A.M. reports a relationship with Omron Healthcare that includes: speaking and lecture fees. N.A.M. reports a relationship with Pfizer Inc that includes: speaking and lecture fees. N.A.M. reports a relationship with GE Healthcare that includes: speaking and lecture fees. J.J.B. reports a relationship with Abbott Vascular Inc that includes: speaking and lecture fees. J.J.B. reports a relationship with Edwards Lifesciences Corporation that includes: speaking and lecture fees. J.J.B. reports a relationship with Omron Healthcare that includes: speaking and lecture fees. A.P.C. reports a relationship with Turku PET Centre that includes: funding grants. D.L. reports a relationship with Turku PET Centre that includes: funding grants. C.S. reports a relationship with Turku PET Centre that includes: funding grants. P.L.S. reports a relationship with Turku PET Centre that includes: funding grants. T.N. reports a relationship with Turku PET Centre that includes: funding grants. R.M. reports a relationship with Turku PET Centre that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
