Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Eur Heart J. 2011 May;32(9):1089-96. doi: 10.1093/eurheartj/ehr069. Epub 2011 Mar 15.
We evaluated if right ventricular (RV) mechanical dispersion by strain was related to ventricular arrhythmias (VT/VF) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and if mechanical dispersion was increased in so far asymptomatic mutation carriers.
We included 69 patients, 42 had symptomatic ARVC and 27 were mutation positive asymptomatic family members. Forty healthy individuals served as controls. Myocardial strain was assessed in 6 RV and 16 left ventricular (LV) segments. Contraction duration (CD) in 6 RV and 16 LV segments were measured as the time from onset R on electrocardiogram to maximum myocardial shortening in each segment. The standard deviation of CD was defined as mechanical dispersion. Mechanical dispersion was more pronounced in ARVC patients with arrhythmias compared with asymptomatic mutation carriers and healthy individuals in RV [52(41,63) vs. 35(23,47) vs. 13(9,19)ms, P < 0.001]. Mechanical dispersion was more pronounced in asymptomatic mutation carriers compared with healthy individuals (P < 0.001). Right ventricular mechanical dispersion predicted VT/VF in a multivariate logistic regression analysis [odds ratio (OR), 1.66 (95% confidence interval (CI) 1.06-2.58), P < 0.03]. Right ventricular and LV function by strain were reduced in symptomatic ARVC patients and correlated significantly (R = 0.81, P < 0.001). Right ventricular and LV strain were reduced in asymptomatic mutation carriers compared with healthy individuals (P < 0.001).
Right ventricular mechanical dispersion was pronounced in patients with ARVC with VT/VF. Right ventricular mechanical dispersion was present in asymptomatic mutation carriers and may be helpful in risk stratification. Right ventricular and LV function correlated in ARVC patients implying that ARVC is a biventricular disease.
我们评估右心室（RV）应变机械离散度与心律失常性右室心肌病（ARVC）患者室性心律失常（VT/VF）的关系，以及机械离散度是否在无症状突变携带者中增加。
我们纳入了 69 名患者，其中 42 名患有有症状的 ARVC，27 名是无症状突变阳性的家族成员。40 名健康个体作为对照组。我们评估了 6 个 RV 和 16 个左心室（LV）节段的心肌应变。在 6 个 RV 和 16 个 LV 节段中测量收缩期持续时间（CD），即心电图上 R 波起始至每个节段心肌最短化的最大时间。CD 的标准差定义为机械离散度。与无症状突变携带者和健康个体相比，心律失常的 ARVC 患者的 RV 机械离散度更为明显[52（41，63）比 35（23，47）比 13（9，19）ms，P<0.001]。与健康个体相比，无症状突变携带者的机械离散度更为明显（P<0.001）。在多变量逻辑回归分析中，RV 机械离散度预测 VT/VF[比值比（OR），1.66（95%置信区间（CI），1.06-2.58），P<0.03]。有症状的 ARVC 患者的 RV 和 LV 应变功能降低，且显著相关（R=0.81，P<0.001）。与健康个体相比，无症状突变携带者的 RV 和 LV 应变均降低（P<0.001）。
ARVC 合并 VT/VF 的患者 RV 机械离散度明显。无症状突变携带者存在 RV 机械离散度，有助于风险分层。ARVC 患者的 RV 和 LV 功能相关，提示 ARVC 是一种双心室疾病。
