Utility of Left and Right Ventricular Strain in Arrhythmogenic Right Ventricular Cardiomyopathy: A Prospective Multicenter Registry.
Utility of Left and Right Ventricular Strain in Arrhythmogenic Right Ventricular Cardiomyopathy: A Prospective Multicenter Registry.
复制标题
左心室应变和右心室应变在致心律失常性右心室心肌病中的效用：前瞻性多中心登记。
DOI：
10.1161/circimaging.123.015671
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
NorthAmericanARVC
中科院分区：
文献类型：
--
作者：
Namasivayam,Mayooran;Bertrand,PhilippeB;Bernard,Samuel;Churchill,TimothyW;Khurshid,Shaan;Marcus,FrankI;Mestroni,Luisa;Saffitz,JeffreyE;Towbin,JeffreyA;Zareba,Wojciech;Picard,MichaelH;Sanborn,DanitaYoerger;NorthAmericanARVC
背景致心律失常性右心室心肌病（ARVC）的影像学评估仍然具有挑战性。通过超声心动图进行心肌应变评估是一种越来越多地用于检测亚临床左心室（LV）和右心室（RV）功能障碍的技术。我们的目的是评估 LV 和 RV 应变在 ARVC 中的诊断和预后效用。方法使用 2010 年 ARVC 修订工作组标准对多中心登记处疑似 ARVC 的患者 (n = 109) 进行临床表型分析，并进行基线应变超声心动图检查。根据 2010 年 ARVC 修订工作组标准，使用受试者工作特征曲线下面积分析评估 LV 和 RV 应变的诊断性能，并使用 Kaplan-Meier 分析评估预后价值。 结果平均年龄为 45.3±14.7 岁，48% 的患者为女性。 RV 应变的估计对于 99/109 (91%) 的患者是可行的，而 LV 应变的估计对于 85/109 (78%) 的患者是可行的。根据 2010 年 ARVC 修订工作组标准，在进行 RV 应变测量的患者中，ARVC 患病率分别为 91/109 (83%) 和 83/99 (84%)。 RV 整体纵向应变和 RV 游离壁应变在受试者工作特征曲线下的诊断面积分别为 0.76 和 0.77（均 P<0.001；差异 NS）。分别有 41/69 (59%) 和 56/69 (81%) 的受试者发现异常 RV 整体纵向应变表型（RV 整体纵向应变 > -17.9%）和 RV 游离壁应变表型（RV 游离壁应变 > -21.2%），这些受试者未通过传统超声心动图标准识别，但仍符合 2010 年 ARVC 修订后的 ARVC 工作组标准。左心室整体纵向应变并没有增加诊断价值，但对死亡、心脏移植或室性心律失常等复合终点具有预后意义（log-rankP=0.04）。结论在 ARVC 的前瞻性、多中心登记中，右心室应变评估通过识别当前超声心动图标准遗漏但仍符合 ARVC 诊断的患者，为当前超声心动图标准增加了诊断价值。相比之下，左心室应变并没有增加诊断价值，但可以预测高危患者的识别。
BACKGROUNDImaging 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.METHODSPatients 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.RESULTSMean 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 (bothP<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-rankP=0.04).CONCLUSIONSIn 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.