Key result
RV and RA strain independently predict subclinical ARVC and improve diagnostic accuracy over conventional CMR.
Why the study?
ARVC predominantly affects the right heart, but conventional CMR parameters often overlook subclinical ARVC with preserved RV function.
Do right ventricular and right atrial strain parameters on cardiac MRI improve the detection of subclinical arrhythmogenic right ventricular cardiomyopathy compared to conventional CMR parameters?
Do right ventricular and right atrial strain parameters on cardiac MRI improve the detection of subclinical arrhythmogenic right ventricular cardiomyopathy compared to conventional CMR parameters?
Right ventricular global longitudinal strain and right atrial conduit strain derived from cardiac MRI feature tracking are sensitive markers that improve the early detection of subclinical ARVC compared to conventional CMR parameters.
RV and RA strain on CMR may aid subclinical ARVC detection; hypothesis-generating and requires prospective validation before practice change.
Aims Arrhythmogenic right ventricular cardiomyopathy (ARVC) predominantly affects the right heart, but conventional Cardiac MRI (CMR) parameters often overlook subclinical ARVC with preserved right ventricular (RV) function. This study evaluates the diagnostic value of RV and right atrial (RA) strain in subclinical ARVC patients. Methods In this single-center retrospective study, 123 participants were enrolled, including 41 patients with subclinical ARVC (mean age 39±16 years, 25 men), 41 patients with impaired ARVC (mean age 40±17 years, 27 men), and 41 healthy controls (mean age 39±11 years, 25 men) between January 2010 and October 2020. Right ventricular and right atrial strain parameters were obtained using CMR FT. Univariate and stepwise multivariate binary logistic regression analyses were conducted to identify CMR-derived independent predictors of subclinical ARVC. Incremental diagnostic value was assessed using C indices. Results RA and RV strain, along with conventional CMR parameters, were assessed in 41 definite subclinical ARVC patients with preserved RV function, compared to 41 definite impaired ARVC patients with RV dysfunction and 41 healthy controls. RA reservoir strain, conduit strain, and RV global longitudinal strain (RVGLS) were significantly reduced in the subclinical ARVC group compared to controls. Receiver operating characteristic analysis revealed that RVGLS > -19% [area under the curve (AUC): 0.85] and RA conduit strain < 17% (AUC: 0.80) outperformed other CMR conventional parameters in diagnosing subclinical ARVC. Multivariable logistic regression identified RVGLS [odds ratio (OR): 1.39, P < 0.01] and RA conduit strain (OR: 0.87, P < 0.01) as independent predictors of subclinical ARVC diagnosis. RA conduit strain was significantly negatively correlated with N-terminal pro brain natriuretic peptide (NT-proBNP) levels (r = -0.44, P < 0.01). Combined evaluation of RVGLS and RA conduit strain significantly improved diagnostic accuracy based on CMR-derived structural and volumetric parameters. Conclusion RVGLS and RA conduit strain are sensitive markers for early detection of subclinical ARVC, outperforming conventional CMR parameters, with their combined evaluation further improving diagnostic accuracy.
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Xu et al. (2025) studied this question. RV global longitudinal strain > -19% (AUC 0.85) and RA conduit strain < 17% (AUC 0.80) independently predict subclinical ARVC and improve diagnostic accuracy.
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