Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences SZ University Town Shenzhen China.
J Am Heart Assoc. 2024 Jan 2;13(1):e031403. doi: 10.1161/JAHA.123.031403. Epub 2023 Dec 29.
Strain analysis is a sensitive method for the assessment of ventricular structural or functional alterations. The authors aimed to determine whether right ventricular (RV) strain parameters can discriminate patients with revised Task Force Criteria-diagnosed arrhythmogenic RV cardiomyopathy (ARVC) incremental to the existing cardiovascular magnetic resonance (CMR) criteria, thus improving the diagnostic yield of CMR in ARVC.
A total of 74 patients with revised Task Force Criteria-diagnosed ARVC (37 borderline and 37 definite) and 37 controls were retrospectively enrolled for analysis. Using CMR feature tracking, RV global longitudinal (GLS), circumferential, and radial strain of all participants were evaluated. Compared with controls, the study patients demonstrated significantly impaired global biventricular strain in all 3 directions (all <0.001). Receiver operating characteristic curve analysis indicated that RV GLS was the strongest discriminator among all RV strain parameters for the identification of patients with ARVC (area under the curve, 0.92). Using the Youden index, the authors determined RV GLS ≥-19.95% as the diagnostic criterion of ARVC. In patients diagnosed with borderline ARVC according to revised Task Force Criteria but with no or only minor CMR criteria, there were >50% presenting with impaired RV GLS. When both conventional criteria and RV GLS were considered together, this new diagnostic method demonstrated an overall diagnostic accuracy of 90%. The likelihood ratio test showed a significant incremental diagnostic value of RV GLS (=0.02) over the existing CMR major criteria.
The current study showed an improved diagnostic accuracy when both RV GLS and the existing CMR criteria were considered together, especially for patients with borderline diagnosis, suggesting the incremental value of strain analysis to the initial assessment of ARVC.
应变分析是评估心室结构或功能改变的一种敏感方法。作者旨在确定右心室（RV）应变参数是否可以区分经修正的Task Force 标准诊断的致心律失常性右室心肌病（ARVC）患者，与现有的心血管磁共振（CMR）标准相比，从而提高 ARVC 的 CMR 诊断率。
回顾性纳入了 74 例经修正的Task Force 标准诊断的 ARVC 患者（37 例边界性和 37 例明确性）和 37 例对照者进行分析。使用 CMR 特征追踪，评估了所有参与者的 RV 整体纵向（GLS）、周向和径向应变。与对照组相比，研究患者在所有 3 个方向上均表现出明显的整体双心室应变受损（均<0.001）。受试者工作特征曲线分析表明，RV GLS 是所有 RV 应变参数中识别 ARVC 患者的最强鉴别指标（曲线下面积，0.92）。使用 Youden 指数，作者确定 RV GLS ≥-19.95%为 ARVC 的诊断标准。在根据修正的 Task Force 标准诊断为边界性 ARVC 但 CMR 标准无或仅有轻微异常的患者中，>50%的患者 RV GLS 受损。当同时考虑常规标准和 RV GLS 时，这种新的诊断方法的总体诊断准确性为 90%。似然比检验显示 RV GLS 具有显著的增量诊断价值（=0.02），超过了现有的 CMR 主要标准。
当同时考虑 RV GLS 和现有的 CMR 标准时，本研究显示出了提高的诊断准确性，尤其是对于边界性诊断的患者，提示应变分析对 ARVC 的初始评估具有增量价值。
