Key result
Reduced RV free wall longitudinal strain is linked to MACE in ARVC patients.
Why the study?
ARVC carries an elevated risk of life-threatening arrhythmias and ventricular impairment, requiring risk stratification to determine the incremental prognostic value of speckle-tracking strain over conventional echocardiographic parameters.
Does strain measured by two-dimensional speckle-tracking echocardiography predict MACE better than conventional echocardiographic parameters in patients with ARVC?
Cohort (n=83)
No
Does strain measured by two-dimensional speckle-tracking echocardiography predict MACE better than conventional echocardiographic parameters in patients with ARVC?
Right ventricular free wall longitudinal strain measured by speckle-tracking echocardiography is a sensitive predictor of major adverse cardiac events in patients with ARVC.
Answers are grounded in this paper and cite their sources.
RV free wall strain was associated with MACE in ARVC; hypothesis-generating and requires prospective validation before guiding risk stratification.
Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic disorder associated with an elevated risk of life-threatening arrhythmias and progressive ventricular impairment. Risk stratification is essential to prevent major adverse cardiac events (MACE). Our study aimed to investigate the incremental value of strain measured by two-dimensional speckle-tracking echocardiography in predicting MACE in ARVC patients compared to conventional echocardiographic parameters. Methods and Results This was a retrospective, single-centre cohort study of 83 patients with ARVC (51% males, median age 37 years (IQR: 23, 53)) under the care of the Inherited Cardiac Conditions clinic at University Hospital Birmingham. MACE was defined as one of the following: sustained ventricular tachycardia (Sus VT), ventricular fibrillation (VF), appropriate implantable cardio-defibrillator (ICD) therapy [shock/anti-tachycardia pacing (ATP)], heart failure (defined as decompensated heart failure, cardiac index by heart catheter, HF medication, and symptoms), cardiac transplantation, or cardiac death. Echocardiography images were analysed by a single observer for right ventricle (RV) and left ventricular (LV) global longitudinal strain (GLS). Multivariable Cox regression was performed in combination with RV fractional area change and tricuspid annular plane systolic excursion. During three years of follow-up, 12% of patients suffered a MACE. ARVC patients with MACE had significantly reduced RV GLS (−13 ± 6% vs. −23 ± 6%, p < 0.001) and RV free wall longitudinal strain (−15 ± 5% vs. −25 ± 7%, p < 0.001) compared to those without MACE. Conclusions Right ventricular free wall longitudinal strain (RVFWLS) may be a more sensitive predictor of MACE than conventional echocardiographic parameters of RV function. Moreover, RV-free wall longitudinal strain may have superior predictive value compared to RV GLS.
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Aljehani et al. (2024) conducted a cohort in Arrhythmogenic right ventricular cardiomyopathy (ARVC) (n=83). Right ventricular free wall longitudinal strain (RVFWLS) and RV global longitudinal strain (GLS) vs. Conventional echocardiographic parameters was evaluated on Major adverse cardiac events (MACE) including sustained VT, VF, appropriate ICD therapy, heart failure, cardiac transplantation, or cardiac death (p=< 0.001). Right ventricular free wall longitudinal strain was significantly reduced in ARVC patients who experienced MACE compared to those who did not (-15 ± 5% vs. -25 ± 7%, p < 0.001).
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