Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland.
Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland.
Eur Heart J Cardiovasc Imaging. 2024 Jul 31;25(8):1061-1068. doi: 10.1093/ehjci/jeae117.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive myocardial dysfunction and associated with an increased risk of major cardiovascular (CV) events. To determine right heart strain (ventricular and atrial global longitudinal strain (RVGLS and RAGLS) in patients with definite ARVC and its association with adverse events during follow-up.
RVGLS and RAGLS were analysed in focused right heart apical views from 70 patients using TomTec ImageArena and association with a composite endpoint was determined (sustained ventricular arrhythmia and cardiovascular death). Over a median follow-up duration of 4.9 years, 26 (37%) patients met the endpoint. RVGLS was significantly impaired in the event group (-11.5 [-13.3 to -10.2] %) vs. the no-event group (-15.8 [-17.1 to -14.5] %, P < 0.001), and so was RAGLS (22.8 [21.4-27.4] % vs. 31.5 [25.1-39.6] %, respectively, P < 0.001). In Cox regression, RVGLS (HR 1.36, P < 0.001) and RAGLS (HR 0.92, P = 0.002) were associated with a higher risk of adverse events. In multivariable Cox regression models, RVGLS and RAGLS remained independent of and were incremental to age, gender, and conventional RV parameters, and model fitness was improved when RVGLS and RAGLS were applied together rather than alone.
RVGLS and RAGLS are more impaired in patients with adverse events and associated with adverse events independent of age, gender, and conventional RV parameters. When RVGLS and RAGLS are applied together, prediction models are improved suggesting that right heart strain may form part of the echocardiographic routine protocol in patients with ARVC.
致心律失常性右室心肌病（ARVC）的特征是进行性心肌功能障碍，并伴有心血管（CV）主要事件风险增加。本研究旨在确定明确 ARVC 患者的右心应变（心室和心房整体纵向应变（RVGLS 和 RAGLS））及其与随访期间不良事件的关系。
使用 TomTec ImageArena 从 70 例患者的右心心尖的聚焦视图中分析 RVGLS 和 RAGLS，并确定与复合终点的相关性（持续性室性心律失常和心血管死亡）。在中位数为 4.9 年的随访期间，26 例（37%）患者达到了终点。与无事件组相比，事件组的 RVGLS 明显受损（-11.5[-13.3 至-10.2]%，P<0.001），RAGLS 也明显受损（-11.5[-13.3 至-10.2]%，P<0.001）。在 Cox 回归中，RVGLS（HR 1.36，P<0.001）和 RAGLS（HR 0.92，P=0.002）与不良事件的风险增加相关。在多变量 Cox 回归模型中，RVGLS 和 RAGLS 独立于年龄、性别和传统 RV 参数，并且当 RVGLS 和 RAGLS 一起应用而不是单独应用时，模型拟合度得到改善。
RVGLS 和 RAGLS 在发生不良事件的患者中受损更严重，并且与年龄、性别和传统 RV 参数无关，与不良事件相关。当 RVGLS 和 RAGLS 一起应用时，预测模型得到改善，这表明右心应变可能成为 ARVC 患者超声心动图常规方案的一部分。
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