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Enhancing Arrhythmogenic Right Ventricular Cardiomyopathy Detection and Risk Stratification: Insights from Advanced
Natália Olivetti1,2, Luciana Sacilotto1, Danilo Bora Moleta3
1Arrhythmia Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil.
Insights
Advanced echocardiography, including right ventricular (RV) strain, improves arrhythmogenic right ventricular cardiomyopathy (ARVC) detection. Abnormal RV strain is linked to adverse arrhythmic outcomes, aiding in risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Genetics
Background:
- Arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnosis via echocardiography has low sensitivity, particularly in early stages.
- Echocardiographic strain may enhance detection of subtle right ventricular (RV) functional abnormalities in ARVC.
- The diagnostic and prognostic value of advanced echocardiographic measures, including RV strain, in ARVC requires further elucidation.
Purpose of the Study:
- To assess if advanced echocardiographic measures, specifically RV strain, improve ARVC detection.
- To evaluate the diagnostic value of these advanced echocardiographic parameters compared to conventional methods.
- To determine the association between echocardiographic parameters and arrhythmic outcomes in ARVC patients.
Main Methods:
- Retrospective analysis of 28 patients with a confirmed ARVC diagnosis from the Heart Institute of São Paulo.
- Application of advanced echocardiographic techniques, including RV strain analysis.
- Comparison of echocardiographic parameters with conventional echocardiography and cardiac magnetic resonance (CMR).
Main Results:
- In the cohort, 50% of patients experienced sustained ventricular arrhythmic events.
- RV dilatation (RVDd, RVOT PSAX) and reduced RV free wall longitudinal strain (< 14.35% absolute value) were significantly associated with arrhythmic outcomes.
- Advanced echocardiographic techniques were utilized in the assessment of the ARVC cohort.
Conclusions:
- Advanced echocardiographic techniques, including RV strain, show promise in improving ARVC detection.
- Abnormal RV strain is associated with arrhythmic risk, suggesting its utility in risk stratification.
- Further research is needed to validate these findings and integrate them into ARVC risk assessment protocols.
Introduction:
The echocardiographic diagnosis criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are highly specific but sensitivity is low, especially in the early stages of the disease. The role of echocardiographic strain in ARVC has not been fully elucidated, although prior studies suggest that it can improve the detection of subtle functional abnormalities. The purposes of the study were to determine whether these advanced measures of right ventricular (RV) dysfunction on echocardiogram, including RV strain, increase diagnostic value for ARVC disease detection and to evaluate the association of echocardiographic parameters with arrhythmic outcomes.
Methods:
The study included 28 patients from the Heart Institute of São Paulo ARVC cohort with a definite diagnosis of ARVC established according to the 2010 Task Force Criteria. All patients were submitted to ECHO's advanced techniques including RV strain, and the parameters were compared to prior conventional visual ECHO and CMR.
Results:
In total, 28 patients were enrolled in order to perform ECHO's advanced techniques. A total of 2/28 (7%) patients died due to a cardiovascular cause, 2/28 (7%) underwent heart transplantation, and 14/28 (50%) patients developed sustained ventricular arrhythmic events. Among ECHO's parameters, RV dilatation, measured by RVDd (p = 0.018) and RVOT PSAX (p = 0.044), was significantly associated with arrhythmic outcomes. RV free wall longitudinal strain < 14.35% in absolute value was associated with arrhythmic outcomes (p = 0.033).
Conclusion:
Our data suggest that ECHO's advanced techniques improve ARVC detection and that abnormal RV strain can be associated with arrhythmic risk stratification. Further studies are necessary to better demonstrate these findings and contribute to risk stratification in ARVC, in addition to other well-known risk markers.
