Prognostic value of strain by speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy

Areej Aljehani; Kyaw Zaw Win; Shanat Baig; Manish Kalla; Bode Ensam; Larissa Fabritz; Richard P. Steeds

doi:10.3390/jcdd11120388

Prognostic value of strain by speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy

Areej Aljehani
, Kyaw Zaw Win
, Shanat Baig
, Manish Kalla
, Bode Ensam
, Larissa Fabritz
, Richard P. Steeds^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic disorder associated with an elevated risk of life-threatening arrhythmias and progressive ventricular impairment. Risk stratification is essential to prevent major adverse cardiac events (MACE). Our study aimed to investigate the incremental value of strain measured by two-dimensional speckle-tracking echocardiography in predicting MACE in ARVC patients compared to conventional echocardiographic parameters.

Methods and Results This was a retrospective, single-centre cohort study of 83 patients with ARVC (51% males, median age 37 years (IQR: 23, 53)) under the care of the Inherited Cardiac Conditions clinic at University Hospital Birmingham. MACE was defined as one of the following: sustained ventricular tachycardia (Sus VT), ventricular fibrillation (VF), appropriate implantable cardio-defibrillator (ICD) therapy [shock/anti-tachycardia pacing (ATP)], heart failure (defined as decompensated heart failure, cardiac index by heart catheter, HF medication, and symptoms), cardiac transplantation, or cardiac death. Echocardiography images were analysed by a single observer for right ventricle (RV) and left ventricular (LV) global longitudinal strain (GLS). Multivariable Cox regression was performed in combination with RV fractional area change and tricuspid annular plane systolic excursion. During three years of follow-up, 12% of patients suffered a MACE. ARVC patients with MACE had significantly reduced RV GLS (−13 ± 6% vs. −23 ± 6%, p < 0.001) and RV free wall longitudinal strain (−15 ± 5% vs. −25 ± 7%, p < 0.001) compared to those without MACE.

Conclusions Right ventricular free wall longitudinal strain (RVFWLS) may be a more sensitive predictor of MACE than conventional echocardiographic parameters of RV function. Moreover, RV-free wall longitudinal strain may have superior predictive value compared to RV GLS.

Original language	English
Article number	388
Number of pages	14
Journal	Journal of Cardiovascular Development and Disease
Volume	11
Issue number	12
DOIs	https://doi.org/10.3390/jcdd11120388
Publication status	Published - 3 Dec 2024

Bibliographical note

Publisher Copyright:
© 2024 by the authors.

Keywords

arrhythmogenic right ventricular cardiomyopathy
global longitudinal strain
prognosis
speckle tracking
transthoracic echocardiography

ASJC Scopus subject areas

General Pharmacology, Toxicology and Pharmaceutics
Pharmacology (medical)

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MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation
Kirchhof, P. (Researcher), Gkoutos, G. (Principal Investigator) & Fabritz, L. (Researcher)
European Commission
1/03/21 → 31/08/26
Project: EU
H2020_COLLAB_CATCH ME_(LEAD)
Kirchhof, P. (Principal Investigator), Fabritz, L. (Co-Investigator), Hemming, K. (Co-Investigator) & Deeks, J. (Co-Investigator)
European Commission
1/05/15 → 30/04/19
Project: EU

Cite this

@article{90837d6b0bfc4bd7916d5ed47843ef53,

title = "Prognostic value of strain by speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy",

abstract = "Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic disorder associated with an elevated risk of life-threatening arrhythmias and progressive ventricular impairment. Risk stratification is essential to prevent major adverse cardiac events (MACE). Our study aimed to investigate the incremental value of strain measured by two-dimensional speckle-tracking echocardiography in predicting MACE in ARVC patients compared to conventional echocardiographic parameters. Methods and Results This was a retrospective, single-centre cohort study of 83 patients with ARVC (51\% males, median age 37 years (IQR: 23, 53)) under the care of the Inherited Cardiac Conditions clinic at University Hospital Birmingham. MACE was defined as one of the following: sustained ventricular tachycardia (Sus VT), ventricular fibrillation (VF), appropriate implantable cardio-defibrillator (ICD) therapy [shock/anti-tachycardia pacing (ATP)], heart failure (defined as decompensated heart failure, cardiac index by heart catheter, HF medication, and symptoms), cardiac transplantation, or cardiac death. Echocardiography images were analysed by a single observer for right ventricle (RV) and left ventricular (LV) global longitudinal strain (GLS). Multivariable Cox regression was performed in combination with RV fractional area change and tricuspid annular plane systolic excursion. During three years of follow-up, 12\% of patients suffered a MACE. ARVC patients with MACE had significantly reduced RV GLS (−13 ± 6\% vs. −23 ± 6\%, p < 0.001) and RV free wall longitudinal strain (−15 ± 5\% vs. −25 ± 7\%, p < 0.001) compared to those without MACE. Conclusions Right ventricular free wall longitudinal strain (RVFWLS) may be a more sensitive predictor of MACE than conventional echocardiographic parameters of RV function. Moreover, RV-free wall longitudinal strain may have superior predictive value compared to RV GLS.",

keywords = "arrhythmogenic right ventricular cardiomyopathy, global longitudinal strain, prognosis, speckle tracking, transthoracic echocardiography",

author = "Areej Aljehani and Win, \{Kyaw Zaw\} and Shanat Baig and Manish Kalla and Bode Ensam and Larissa Fabritz and Steeds, \{Richard P.\}",

note = "Publisher Copyright: {\textcopyright} 2024 by the authors.",

year = "2024",

month = dec,

day = "3",

doi = "10.3390/jcdd11120388",

language = "English",

volume = "11",

journal = "Journal of Cardiovascular Development and Disease",

issn = "2308-3425",

publisher = "MDPI",

number = "12",

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TY - JOUR

T1 - Prognostic value of strain by speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy

AU - Aljehani, Areej

AU - Win, Kyaw Zaw

AU - Baig, Shanat

AU - Kalla, Manish

AU - Ensam, Bode

AU - Fabritz, Larissa

AU - Steeds, Richard P.

PY - 2024/12/3

Y1 - 2024/12/3

N2 - Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic disorder associated with an elevated risk of life-threatening arrhythmias and progressive ventricular impairment. Risk stratification is essential to prevent major adverse cardiac events (MACE). Our study aimed to investigate the incremental value of strain measured by two-dimensional speckle-tracking echocardiography in predicting MACE in ARVC patients compared to conventional echocardiographic parameters. Methods and Results This was a retrospective, single-centre cohort study of 83 patients with ARVC (51% males, median age 37 years (IQR: 23, 53)) under the care of the Inherited Cardiac Conditions clinic at University Hospital Birmingham. MACE was defined as one of the following: sustained ventricular tachycardia (Sus VT), ventricular fibrillation (VF), appropriate implantable cardio-defibrillator (ICD) therapy [shock/anti-tachycardia pacing (ATP)], heart failure (defined as decompensated heart failure, cardiac index by heart catheter, HF medication, and symptoms), cardiac transplantation, or cardiac death. Echocardiography images were analysed by a single observer for right ventricle (RV) and left ventricular (LV) global longitudinal strain (GLS). Multivariable Cox regression was performed in combination with RV fractional area change and tricuspid annular plane systolic excursion. During three years of follow-up, 12% of patients suffered a MACE. ARVC patients with MACE had significantly reduced RV GLS (−13 ± 6% vs. −23 ± 6%, p < 0.001) and RV free wall longitudinal strain (−15 ± 5% vs. −25 ± 7%, p < 0.001) compared to those without MACE. Conclusions Right ventricular free wall longitudinal strain (RVFWLS) may be a more sensitive predictor of MACE than conventional echocardiographic parameters of RV function. Moreover, RV-free wall longitudinal strain may have superior predictive value compared to RV GLS.

AB - Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic disorder associated with an elevated risk of life-threatening arrhythmias and progressive ventricular impairment. Risk stratification is essential to prevent major adverse cardiac events (MACE). Our study aimed to investigate the incremental value of strain measured by two-dimensional speckle-tracking echocardiography in predicting MACE in ARVC patients compared to conventional echocardiographic parameters. Methods and Results This was a retrospective, single-centre cohort study of 83 patients with ARVC (51% males, median age 37 years (IQR: 23, 53)) under the care of the Inherited Cardiac Conditions clinic at University Hospital Birmingham. MACE was defined as one of the following: sustained ventricular tachycardia (Sus VT), ventricular fibrillation (VF), appropriate implantable cardio-defibrillator (ICD) therapy [shock/anti-tachycardia pacing (ATP)], heart failure (defined as decompensated heart failure, cardiac index by heart catheter, HF medication, and symptoms), cardiac transplantation, or cardiac death. Echocardiography images were analysed by a single observer for right ventricle (RV) and left ventricular (LV) global longitudinal strain (GLS). Multivariable Cox regression was performed in combination with RV fractional area change and tricuspid annular plane systolic excursion. During three years of follow-up, 12% of patients suffered a MACE. ARVC patients with MACE had significantly reduced RV GLS (−13 ± 6% vs. −23 ± 6%, p < 0.001) and RV free wall longitudinal strain (−15 ± 5% vs. −25 ± 7%, p < 0.001) compared to those without MACE. Conclusions Right ventricular free wall longitudinal strain (RVFWLS) may be a more sensitive predictor of MACE than conventional echocardiographic parameters of RV function. Moreover, RV-free wall longitudinal strain may have superior predictive value compared to RV GLS.

KW - arrhythmogenic right ventricular cardiomyopathy

KW - global longitudinal strain

KW - prognosis

KW - speckle tracking

KW - transthoracic echocardiography

UR - https://www.scopus.com/pages/publications/85213538753

U2 - 10.3390/jcdd11120388

DO - 10.3390/jcdd11120388

M3 - Article

AN - SCOPUS:85213538753

SN - 2308-3425

VL - 11

JO - Journal of Cardiovascular Development and Disease

JF - Journal of Cardiovascular Development and Disease

IS - 12

M1 - 388

ER -

Prognostic value of strain by speckle tracking echocardiography in patients with arrhythmogenic right ventricular cardiomyopathy

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

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Projects

MAESTRIA: Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation

H2020_COLLAB_CATCH ME_(LEAD)

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