Key result
Normal biventricular strain linked to ~68% lower risk of adverse events in ARVC.
Why the study?
Although LV involvement occurs in ARVC and strain imaging detects ventricular dysfunction, data regarding the prognostic value of combining biventricular strain for risk stratification are lacking.
Does biventricular strain impairment (assessed by LV GLS and RV FWLS) predict adverse clinical outcomes in patients with ARVC?
Cohort (n=204)
No
Does biventricular strain impairment (assessed by LV GLS and RV FWLS) predict adverse clinical outcomes in patients with ARVC?
Hazard Ratio: 0.316 (95% CI 0.135–0.741)
p-value: p=0.008
Biventricular strain analysis using a cutoff of 18% for both LV GLS and RV FWLS provides independent prognostic value for risk stratification in patients with ARVC.
May aid ARVC risk stratification; extends strain sensitivity data but leaves practice change open.
Despite arrhythmogenic right ventricular cardiomyopathy (ARVC) being predominantly a right ventricular (RV) disease, concomitant left ventricular (LV) involvement has been recognized. ARVC is diagnosed by the RV-centric 2010 Task Force Criteria(TFC) using routine echocardiography, but previous studies have suggested that strain imaging may be more sensitive to detect RV and LV dysfunction. No data however are available regarding the additional value of combining biventricular strain for risk stratification. This study aims to assess the prognostic value of both LV global longitudinal strain (GLS) and RV free wall strain (FWLS) in patients with ARVC. To accomplish this, 204 patients who met the TFC for the ARVC spectrum were included. Patients (age 41 ± 17 years,55% men) were divided into impaired(n = 33), discordant (RV or LV impaired, n = 70), and normal (n = 101) strain groups based on a value of ≥18% for both ventricles. During a follow-up of 87 [24-136] months, 57 (28%) experienced the composite outcome of all-cause mortality, arrhythmic events, implantable cardioverter defibrillator therapy and heart failure events, and a significant difference in event-free survival was observed (p <0.001) between the 3 groups. In the multivariable analysis, the strain groups remained associated with outcomes (p = 0.014) after adjusting for age, sex, history of syncope and definite ARVC diagnosis. A subanalysis including only definite and borderline diagnosed ARVC confirmed that the strain groups were independently predictive of the endpoint (p = 0.023). In conclusion, biventricular involvement by strain analysis may help risk stratification in ARVC patients, with the worst outcomes of patients with both RV and LV impaired strain.
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Chua et al. (2025) conducted a cohort in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) (n=204). Normal biventricular strain (LV GLS and RV FWLS ≥18%) vs. Impaired biventricular strain (LV GLS and RV FWLS <18%) was evaluated on Composite of all-cause mortality, ventricular arrhythmic events, appropriate implantable cardioverter defibrillator therapy, and heart failure events (HR 0.316, 95% CI 0.135-0.741, p=0.008). In patients with arrhythmogenic right ventricular cardiomyopathy, normal biventricular strain was associated with a significantly lower risk of adverse clinical events compared to impaired biventricular strain (HR 0.316).
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