Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.N., P.B.B., S.B., T.W.C., S.K., M.H.P., D.Y.S.).
Department of Cardiology, St Vincent's Hospital, Faculty of Medicine and Health, University of New South Wales, Victor Chang Cardiac Research Institute, Sydney, Australia (M.N.).
Circ Cardiovasc Imaging. 2023 Dec;16(12):e015671. doi: 10.1161/CIRCIMAGING.123.015671. Epub 2023 Dec 19.
Imaging evaluation of arrhythmogenic right ventricular cardiomyopathy (ARVC) remains challenging. Myocardial strain assessment by echocardiography is an increasingly utilized technique for detecting subclinical left ventricular (LV) and right ventricular (RV) dysfunction. We aimed to evaluate the diagnostic and prognostic utility of LV and RV strain in ARVC.
Patients with suspected ARVC (n = 109) from a multicenter registry were clinically phenotyped using the 2010 ARVC Revised Task Force Criteria and underwent baseline strain echocardiography. Diagnostic performance of LV and RV strain was evaluated using the area under the receiver operating characteristic curve analysis against the 2010 ARVC Revised Task Force Criteria, and the prognostic value was assessed using the Kaplan-Meier analysis.
Mean age was 45.3±14.7 years, and 48% of patients were female. Estimation of RV strain was feasible in 99/109 (91%), and LV strain was feasible in 85/109 (78%) patients. ARVC prevalence by 2010 ARVC Revised Task Force Criteria is 91/109 (83%) and 83/99 (84%) in those with RV strain measurements. RV global longitudinal strain and RV free wall strain had diagnostic area under the receiver operating characteristic curve of 0.76 and 0.77, respectively (both <0.001; difference NS). Abnormal RV global longitudinal strain phenotype (RV global longitudinal strain > -17.9%) and RV free wall strain phenotype (RV free wall strain > -21.2%) were identified in 41/69 (59%) and 56/69 (81%) of subjects, respectively, who were not identified by conventional echocardiographic criteria but still met the overall 2010 ARVC Revised Task Force Criteria for ARVC. LV global longitudinal strain did not add diagnostic value but was prognostic for composite end points of death, heart transplantation, or ventricular arrhythmia (log-rank =0.04).
In a prospective, multicenter registry of ARVC, RV strain assessment added diagnostic value to current echocardiographic criteria by identifying patients who are missed by current echocardiographic criteria yet still fulfill the diagnosis of ARVC. LV strain, by contrast, did not add incremental diagnostic value but was prognostic for identification of high-risk patients.
心律失常性右室心肌病(ARVC)的影像学评估仍然具有挑战性。超声心动图心肌应变评估是一种越来越多地用于检测亚临床左心室(LV)和右心室(RV)功能障碍的技术。我们旨在评估 ARVC 中 LV 和 RV 应变的诊断和预后效用。
来自多中心注册中心的 109 例疑似 ARVC 患者(n = 109)根据 2010 年 ARVC 修订工作组标准进行临床表型分析,并进行基线应变超声心动图检查。使用受试者工作特征曲线分析评估 LV 和 RV 应变的诊断性能,并使用 Kaplan-Meier 分析评估预后价值。
平均年龄为 45.3±14.7 岁,48%的患者为女性。在 109 例患者中,99/109(91%)可进行 RV 应变评估,85/109(78%)可进行 LV 应变评估。根据 2010 年 ARVC 修订工作组标准,ARVC 的患病率为 91/109(83%)和 83/99(84%)。RV 整体纵向应变和 RV 游离壁应变的诊断受试者工作特征曲线下面积分别为 0.76 和 0.77(均<0.001;差异无统计学意义)。在未通过常规超声心动图标准识别但仍符合 ARVC 整体 2010 年 ARVC 修订工作组标准的 69 例患者中,分别有 41/69(59%)和 56/69(81%)例患者出现异常 RV 整体纵向应变表型(RV 整体纵向应变> -17.9%)和 RV 游离壁应变表型(RV 游离壁应变> -21.2%)。LV 整体纵向应变没有增加诊断价值,但对死亡、心脏移植或室性心律失常的复合终点具有预后价值(对数秩检验=0.04)。
在一项前瞻性、多中心 ARVC 注册研究中,RV 应变评估通过识别那些被当前超声心动图标准遗漏但仍符合 ARVC 诊断的患者,为当前的超声心动图标准增加了诊断价值。相比之下,LV 应变没有增加额外的诊断价值,但对识别高危患者具有预后价值。