Related Experiment Video
Updated: May 5, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Prognostic value of right atrial strains in arrhythmogenic right ventricular cardiomyopathy
Jin-Yu Zheng1, Bing-Hua Chen1, Rui Wu1
1Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, People's Republic of China.
Insights
Right atrial strain parameters, including reservoir strain (RARS) and booster strain (RABS), are independent predictors of adverse cardiac events in arrhythmogenic right ventricular cardiomyopathy (ARVC). These measures offer incremental prognostic value beyond traditional risk factors for ARVC patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Genetics
Background:
- Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart condition.
- Fibrofatty infiltration of the heart muscle leads to adverse cardiac events.
- Right atrial (RA) function is increasingly recognized for its prognostic importance.
Purpose of the Study:
- To analyze the prognostic value of right atrial (RA) strain in patients with ARVC.
- To determine if RA strain parameters can predict adverse cardiac events in ARVC.
- To assess the incremental predictive capability of RA strain.
Main Methods:
- Cardiac magnetic resonance (CMR) imaging was used to assess RA strain in 105 ARVC participants.
- Adverse cardiac events were defined as sudden cardiac death, survived cardiac arrest, or appropriate ICD intervention.
- Cox regression and Kaplan-Meier analyses evaluated the association between RA strain and endpoints, with C-index, NRI, and IDI assessing incremental value.
Main Results:
- Reduced RA strain parameters were observed in patients experiencing adverse events.
- Impaired RA reservoir strain (RARS) and booster strain (RABS) were linked to a higher risk of cardiac events.
- RARS and RABS independently predicted adverse events, improving upon conventional risk factors and CMR predictors.
Conclusions:
- RA reservoir strain (RARS) and booster strain (RABS) are independent predictors of adverse cardiac events in ARVC.
- These RA strain parameters offer significant incremental prognostic value.
- Cardiologists should consider RA strain assessment for better long-term outcome prediction and clinical management in ARVC.
Objectives:
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by progressive fibrofatty infiltration of atrial and ventricular myocardium resulting in adverse cardiac events. Atrial function has been increasingly recognized as prognostically important for cardiovascular disease. As the right atrial (RA) strain is a sensitive parameter to describe RA function, we aimed to analyze the prognostic value of the RA strain in ARVC.
Methods:
RA strain parameters were derived from cardiac magnetic resonance (CMR) images of 105 participants with definite ARVC. The endpoint was defined as a combination of sudden cardiac death, survival cardiac arrest, and appropriate implantable cardioverter-defibrillator intervention. Cox regression and Kaplan-Meier survival analyses were performed to evaluate the association between RA strain parameters and endpoint. Concordance index (C index), net reclassification index (NRI), and integrated discrimination improvement (IDI) were calculated to assess the incremental value of RA strain in predicting the endpoint.
Results:
After a median follow-up of 5 years, 36 (34.3%) reaching the endpoint displayed significantly reduced RA strain parameters. At Kaplan-Meier analysis, impaired RA reservoir (RARS) and booster strains (RABS) were associated with an increased risk of the endpoint. After adjusting for conventional risk factors, RARS (hazard ratio [HR], 0.956; p = 0.005) and RABS (HR, 0.906; p = 0.002) resulted as independent predictors for endpoint at Cox regression analyses. In addition, RARS and RABS improved prognostic value to clinical risk factors and CMR morphological and functional predictors (all p < 0.05).
Conclusion:
RARS and RABS were independent predictors for adverse cardiac events, which could provide incremental prognostic value for conventional predictors in ARVC.
Critical Relevance Statement:
We evaluated the prognostic value of right atrial strain in ARVC patients and suggested cardiologists consider RA strain as a predictive parameter when evaluating the long-term outcome of ARVC patients in order to formulate better clinical therapy.
Key Points:
• Patients with ARVC had significantly reduced RA strain and strain rates compared with healthy participants. • Participants with lower RA reservoir and booster stains were associated with a significantly higher risk of adverse cardiac events. • RA booster and reservoir strain provide incremental value to conventional parameters.
More Related Videos
Related Concept Videos
01:20Mitral Regurgitation I: Introduction
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:29Cardiomyopathy IV: Restrictive Cardiomyopathy