Xander Jacquemyn BSc , Jef Van den Eynde MD , Junzhen Zhan MD, PhD , Ashish N. Doshi MD, PhD , William J. Ravekes MD , Nisha A. Gilotra MD , Paul Scheel MD , Katherine C. Wu MD , Alessio Gasperetti MD , Cynthia A. James PhD , Hugh Calkins MD , Brittney Murray MS , Crystal Tichnell MGC, RN , Allison G. Hays MD , Shelby Kutty MD, PhD, MHCM, FRCP
{"title":"Impaired Atrial and Ventricular Strain Predicts Heart Failure in Arrhythmogenic Right Ventricular Cardiomyopathy","authors":"Xander Jacquemyn BSc , Jef Van den Eynde MD , Junzhen Zhan MD, PhD , Ashish N. Doshi MD, PhD , William J. Ravekes MD , Nisha A. Gilotra MD , Paul Scheel MD , Katherine C. Wu MD , Alessio Gasperetti MD , Cynthia A. James PhD , Hugh Calkins MD , Brittney Murray MS , Crystal Tichnell MGC, RN , Allison G. Hays MD , Shelby Kutty MD, PhD, MHCM, FRCP","doi":"10.1016/j.cjca.2024.11.024","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Arrhythmogenic right ventricular cardiomyopathy (ARVC) increases the risk of heart failure (HF) and arrhythmias. Speckle-tracking echocardiography (STE) detects myocardial dysfunction, but its predictive role for HF in this population remains unclear.</div></div><div><h3>Methods</h3><div>Seventy-one patients with ARVC (age 43.7 ± 14.8 years, 53.5% male) without prevalent HF at baseline who were enrolled in the Johns Hopkins ARVC Registry were retrospectively included. Global strain (GS) and strain rate (SR) of the left ventricle (LV), right ventricle free wall (RVFW), left atrium (LA), and right atrium (RA) were measured by a blinded operator. Cox regression models assessed their association with incident HF.</div></div><div><h3>Results</h3><div>Incident HF developed in 23 patients (age 49.3 ± 12.5 years, 52.2% male) during a median follow-up of 2.7 years. Decreases in strain were significantly associated with HF: LV peak global longitudinal systolic strain (GLS; hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.06-1.35; <em>P</em> = 0.003), RVFW strain (HR 1.11, 95% CI 1.04-1.18; <em>P</em> = 0.003), LA GS (HR 1.05, 95% CI 1.00-1.09; <em>P</em> = 0.030), and RA GS (HR 1.07, 95% CI 1.03-1.12; <em>P</em> < 0.001). Associations for LV GLS, RVFW strain, and RA GS remained significant after adjusting for age and sex. Strain values frequently fell below established reference ranges. Any strain value (LV GLS, RVFW strain, LA GS, or RA GS) below the normal limit was associated with an 8-fold increase in HF (HR 8.43, 95% CI 1.97-36.02; <em>P</em> = 0.004), and each individual component below the normal threshold doubled the risk (HR 2.35, 95% CI 1.60-3.45; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>STE deformation abnormalities are associated with incident HF in ARVC patients. Echocardiographic strain may aid in identifying patients at risk of HF for closer follow-up and management.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"41 2","pages":"Pages 215-223"},"PeriodicalIF":5.8000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0828282X24012285","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) increases the risk of heart failure (HF) and arrhythmias. Speckle-tracking echocardiography (STE) detects myocardial dysfunction, but its predictive role for HF in this population remains unclear.
Methods
Seventy-one patients with ARVC (age 43.7 ± 14.8 years, 53.5% male) without prevalent HF at baseline who were enrolled in the Johns Hopkins ARVC Registry were retrospectively included. Global strain (GS) and strain rate (SR) of the left ventricle (LV), right ventricle free wall (RVFW), left atrium (LA), and right atrium (RA) were measured by a blinded operator. Cox regression models assessed their association with incident HF.
Results
Incident HF developed in 23 patients (age 49.3 ± 12.5 years, 52.2% male) during a median follow-up of 2.7 years. Decreases in strain were significantly associated with HF: LV peak global longitudinal systolic strain (GLS; hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.06-1.35; P = 0.003), RVFW strain (HR 1.11, 95% CI 1.04-1.18; P = 0.003), LA GS (HR 1.05, 95% CI 1.00-1.09; P = 0.030), and RA GS (HR 1.07, 95% CI 1.03-1.12; P < 0.001). Associations for LV GLS, RVFW strain, and RA GS remained significant after adjusting for age and sex. Strain values frequently fell below established reference ranges. Any strain value (LV GLS, RVFW strain, LA GS, or RA GS) below the normal limit was associated with an 8-fold increase in HF (HR 8.43, 95% CI 1.97-36.02; P = 0.004), and each individual component below the normal threshold doubled the risk (HR 2.35, 95% CI 1.60-3.45; P < 0.001).
Conclusions
STE deformation abnormalities are associated with incident HF in ARVC patients. Echocardiographic strain may aid in identifying patients at risk of HF for closer follow-up and management.
期刊介绍:
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.