Pergola Valeria, Martini Marika, Amato Filippo, Cozac Dan Alexandru, Deola Petra, Rigato Ilaria, Mattesi Giulia, Savo Maria Teresa, Lassandro Eleonora, Marzari Vittorio, Corradin Simone, De Conti Giorgio, Perazzolo Marra Martina, Motta Raffaella, Bauce Barbara
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy.
University of Medicine, Pharmacy, Science and Technology "George Emil Palade", Gheorghe Marinescu 38, 540142 Târgu Mureș, Romania.
J Clin Med. 2024 Dec 6;13(23):7436. doi: 10.3390/jcm13237436.
Arrhythmogenic cardiomyopathy (ACM) is a genetic disorder characterized by fibrofatty replacement of myocardial tissue, predominantly affecting the right ventricle (RV), but often involving the left ventricle (LV) as well. The early detection of fibrosis, crucial for risk stratification, has been enhanced by advanced imaging techniques. Global longitudinal strain (GLS) has shown promise as a surrogate marker for late enhancement (LE) in identifying myocardial fibrosis, yet precise cut-off values for strain are lacking. The aim of the study is to evaluate LV strain as a predictor of LE in ACM and to define strain cut-offs for early fibrosis detection, enhancing non-invasive diagnostic accuracy. This retrospective single-center study included 64 patients diagnosed with ACM. Echocardiographic analysis using speckle-tracking echocardiography was performed to assess LV strain. LE was evaluated through cardiac magnetic resonance (CMR) or via cardiac computed tomography (CCT) in cases with CMR contraindications. The study aimed to correlate regional LV strain values with the presence of LE, identifying cut-off values predictive of fibrosis. The study found significant correlations between reduced LV strain values and the presence of LE, particularly in the anterolateral and inferolateral segments ( < 0.05). Specific strain thresholds, such as those for segment 12 ( = 0.02) and segment 17 ( = 0.03), were identified as predictive markers for LE. These findings suggest that strain imaging could serve as a non-invasive tool for the early detection of myocardial fibrosis in ACM patients. LV strain analysis offers potential as a non-invasive surrogate marker for myocardial fibrosis in ACM. Incorporating strain imaging into routine echocardiographic evaluations could improve early diagnosis and risk stratification, guiding patient management.
致心律失常性心肌病（ACM）是一种遗传性疾病，其特征是心肌组织被纤维脂肪组织替代，主要影响右心室（RV），但左心室（LV）通常也会受累。先进的成像技术提高了对纤维化的早期检测，这对风险分层至关重要。整体纵向应变（GLS）已显示有望作为识别心肌纤维化的晚期强化（LE）替代标志物，但缺乏应变的精确临界值。本研究的目的是评估左心室应变作为ACM中晚期强化的预测指标，并确定早期纤维化检测的应变临界值，以提高无创诊断准确性。这项回顾性单中心研究纳入了64例诊断为ACM的患者。使用斑点追踪超声心动图进行超声心动图分析以评估左心室应变。对于有磁共振成像（CMR）禁忌证的病例，通过心脏磁共振成像（CMR）或心脏计算机断层扫描（CCT）评估晚期强化。该研究旨在将左心室局部应变值与晚期强化的存在相关联，确定预测纤维化的临界值。研究发现左心室应变值降低与晚期强化的存在之间存在显著相关性，特别是在前外侧和下外侧节段（<0.05）。特定的应变阈值，如节段12（=0.02）和节段17（=0.03），被确定为晚期强化的预测标志物。这些发现表明，应变成像可作为ACM患者心肌纤维化早期检测的无创工具。左心室应变分析有望成为ACM中心肌纤维化的无创替代标志物。将应变成像纳入常规超声心动图评估可改善早期诊断和风险分层，指导患者管理。
