Division of Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Department of Radiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Eur Heart J Cardiovasc Imaging. 2022 Dec 19;24(1):98-107. doi: 10.1093/ehjci/jeac030.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by ventricular dysfunction and ventricular arrhythmias (VA). Adequate arrhythmic risk assessment is important to prevent sudden cardiac death. We aimed to study the incremental value of strain by feature-tracking cardiac magnetic resonance imaging (FT-CMR) in predicting sustained VA in ARVC patients.
CMR images of 132 ARVC patients (43% male, 40.6 ± 16.0 years) without prior VA were analysed for global and regional right and left ventricular (RV, LV) strain. Primary outcome was sustained VA during follow-up. We performed multivariable regression assessing strain, in combination with (i) RV ejection fraction (EF); (ii) LVEF; and (iii) the ARVC risk calculator. False discovery rate adjusted P-values were given to correct for multiple comparisons and c-statistics were calculated for each model. During 4.3 (2.0-7.9) years of follow-up, 19% of patients experienced sustained VA. Compared to patients without VA, those with VA had significantly reduced RV longitudinal (P ≤ 0.03) and LV circumferential (P ≤ 0.04) strain. In addition, patients with VA had significantly reduced biventricular EF (P ≤ 0.02). After correcting for RVEF, LVEF, and the ARVC risk calculator separately in multivariable analysis, both RV and LV strain lost their significance [hazard ratio 1.03-1.18, P > 0.05]. Likewise, while strain improved the c-statistic in combination with RVEF, LVEF, and the ARVC risk calculator separately, this did not reach statistical significance (P ≥ 0.18).
Both RV longitudinal and LV circumferential strain are reduced in ARVC patients with sustained VA during follow-up. However, strain does not have incremental value over RVEF, LVEF, and the ARVC VA risk calculator.
致心律失常性右室心肌病（ARVC）的特征是心室功能障碍和室性心律失常（VA）。充分的心律失常风险评估对于预防心脏性猝死很重要。我们旨在研究特征追踪心脏磁共振成像（FT-CMR）应变的增量值在预测 ARVC 患者持续性 VA 中的作用。
对 132 例无先前 VA 的 ARVC 患者（43%为男性，年龄 40.6±16.0 岁）的 CMR 图像进行分析，以评估整体和局部右、左心室（RV、LV）应变。主要终点为随访期间持续性 VA。我们进行了多变量回归分析，评估了应变与（i）RV 射血分数（EF）；（ii）LVEF；和（iii）ARVC 风险计算器的组合。采用错误发现率调整 P 值进行多重比较校正，并计算每个模型的 c 统计量。在 4.3（2.0-7.9）年的随访中，19%的患者发生持续性 VA。与无 VA 的患者相比，有 VA 的患者 RV 纵向（P≤0.03）和 LV 周向应变（P≤0.04）显著降低。此外，有 VA 的患者双心室 EF 显著降低（P≤0.02）。在多变量分析中分别校正 RVEF、LVEF 和 ARVC 风险计算器后，RV 和 LV 应变均失去意义[风险比 1.03-1.18，P>0.05]。同样，尽管应变与 RVEF、LVEF 和 ARVC 风险计算器分别结合时提高了 c 统计量，但这并没有达到统计学意义（P≥0.18）。
在随访期间持续性 VA 的 ARVC 患者中，RV 纵向和 LV 周向应变均降低。然而，应变在 RVEF、LVEF 和 ARVC VA 风险计算器上没有增量价值。
