Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Dec;16(12):e015671.
doi: 10.1161/CIRCIMAGING.123.015671. Epub 2023 Dec 19.

Utility of Left and Right Ventricular Strain in Arrhythmogenic Right Ventricular Cardiomyopathy: A Prospective Multicenter Registry

Mayooran Namasivayam  1   2 , Philippe B Bertrand  1   3 , Samuel Bernard  1   4 , Timothy W Churchill  1 , Shaan Khurshid  1 , Frank I Marcus  5 , Luisa Mestroni  6 , Jeffrey E Saffitz  7 , Jeffrey A Towbin  8 , Wojciech Zareba  9 , Michael H Picard  1 , Danita Yoerger Sanborn  1 ; North American ARVC Registry
Affiliations
Multicenter Study

Utility of Left and Right Ventricular Strain in Arrhythmogenic Right Ventricular Cardiomyopathy: A Prospective Multicenter Registry

Mayooran Namasivayam et al. Circ Cardiovasc Imaging. 2023 Dec.

Abstract

Background: Imaging evaluation of arrhythmogenic right ventricular cardiomyopathy (ARVC) remains challenging. Myocardial strain assessment by echocardiography is an increasingly utilized technique for detecting subclinical left ventricular (LV) and right ventricular (RV) dysfunction. We aimed to evaluate the diagnostic and prognostic utility of LV and RV strain in ARVC.

Methods: Patients with suspected ARVC (n = 109) from a multicenter registry were clinically phenotyped using the 2010 ARVC Revised Task Force Criteria and underwent baseline strain echocardiography. Diagnostic performance of LV and RV strain was evaluated using the area under the receiver operating characteristic curve analysis against the 2010 ARVC Revised Task Force Criteria, and the prognostic value was assessed using the Kaplan-Meier analysis.

Results: Mean age was 45.3±14.7 years, and 48% of patients were female. Estimation of RV strain was feasible in 99/109 (91%), and LV strain was feasible in 85/109 (78%) patients. ARVC prevalence by 2010 ARVC Revised Task Force Criteria is 91/109 (83%) and 83/99 (84%) in those with RV strain measurements. RV global longitudinal strain and RV free wall strain had diagnostic area under the receiver operating characteristic curve of 0.76 and 0.77, respectively (both P<0.001; difference NS). Abnormal RV global longitudinal strain phenotype (RV global longitudinal strain > -17.9%) and RV free wall strain phenotype (RV free wall strain > -21.2%) were identified in 41/69 (59%) and 56/69 (81%) of subjects, respectively, who were not identified by conventional echocardiographic criteria but still met the overall 2010 ARVC Revised Task Force Criteria for ARVC. LV global longitudinal strain did not add diagnostic value but was prognostic for composite end points of death, heart transplantation, or ventricular arrhythmia (log-rank P=0.04).

Conclusions: In a prospective, multicenter registry of ARVC, RV strain assessment added diagnostic value to current echocardiographic criteria by identifying patients who are missed by current echocardiographic criteria yet still fulfill the diagnosis of ARVC. LV strain, by contrast, did not add incremental diagnostic value but was prognostic for identification of high-risk patients.

Keywords: arrhythmogenic right ventricular dysplasia; diagnosis; echocardiography; prognosis; ventricular dysfunction.

PubMed Disclaimer

Conflict of interest statement

Disclosures Dr Namasivayam received support from the Nvidia Corporation Academic Hardware Grant for work unrelated to this article. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.. Example right ventricular strain analysis.
RV-FWS indicates right ventricular free wall strain; and RV-GLS, right ventricular global longitudinal strain.
Figure 2.
Figure 2.. Diagnostic performance of right ventricular strain in arrhythmogenic right ventricular cardiomyopathy.
Full model details are given in Table 2. AUC indicates area under the receiver operating curve; ROC, receiver operating curve; RV-FWS, right ventricular free wall strain; and RV-GLS, right ventricular global longitudinal strain.
Figure 3.
Figure 3.. Prognostic value of left ventricular strain in arrhythmogenic right ventricular cardiomyopathy showing freedom from composite end point of death (all-cause mortality), heart transplantation, or ventricular arrhythmia.
LV-GLS indicates left ventricular global longitudinal strain.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Corrado D, Link MS, Calkins H. Arrhythmogenic right ventricular cardiomyopathy. N Engl J Med. 2017;376:61–72. doi: 10.1056/NEJMra1509267 - DOI - PubMed
    1. Gandjbakhch E, Redheuil A, Pousset F, Charron P, Frank R. Clinical diagnosis, imaging, and genetics of arrhythmogenic right ventricular cardiomyopathy/dysplasia. J Am Coll Cardiol. 2018;72:784–804. doi: 10.1016/j.jacc.2018.05.065 - DOI - PubMed
    1. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MG, Daubert JP, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121:1533–1541. doi: 10.1161/CIRCULATIONAHA.108.840827 - DOI - PMC - PubMed
    1. Yoerger DM, Marcus F, Sherrill D, Calkins H, Towbin JA, Zareba W, Picard MH; Multidisciplinary Study of Right Ventricular Dysplasia Investigators. Echocardiographic findings in patients meeting task force criteria for arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol. 2005;45:860–865. doi: 10.1016/j.jacc.2004.10.070 - DOI - PubMed
    1. Haugaa KH, Basso C, Badano LP, Bucciarelli-Ducci C, Cardim N, Gaemperli O, Galderisi M, Habib G, Knuuti J, Lancellotti P, et al. Comprehensive multi-modality imaging approach in arrhythmogenic cardiomyopathy – an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J. 2017;18:237–253. doi: 10.1093/ehjci/jew229 - DOI - PMC - PubMed

Publication types

LinkOut - more resources