Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Predicts Adverse Clinical Outcomes: A Cardiovascular Magnetic Resonance Feature Tracking Study

Abstract

The aim of this study was to investigate left ventricular (LV) global myocardial strain and LV involvement characteristics in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and to evaluate their predictive value of adverse cardiac events. Sixty consecutive ARVD/C patients with a definite diagnosis of ARVD/C who underwent CMR examination and thirty-four healthy controls were enrolled retrospectively. The CMR images were analyzed for LV myocardial strain and the presence of LV involvement. The endpoint was defined as a composite of sustained ventricular tachycardia or fibrillation, cardiac death, resuscitated cardiac arrest, heart transplantation, and appropriate implantable cardioverter-defibrillator shock. LV global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were significantly impaired in ARVC/D patients compared to healthy controls (GLS: −13.89 ± 3.26% vs. −16.68 ± 2.74%, GCS: −15.65 ± 3.40% vs. −19.20 ± 2.23%, GRS: 34.57 ± 11.98% vs. 49.92 ± 12.59%; P < 0.001 for all). Even in ARVC/D patients with preserved LVEF, LV GLS, GCS and GRS were also significantly reduced than in controls. During a mean follow-up period of 4.10 ± 1.77 years, the endpoint was reached in 17 patients. LV GLS >−12.65% (HR, 3.58; 95%CI, 1.14 to 11.25; p = 0.029) and history of syncope (HR, 4.99; 95%CI, 1.88 to 13.24; p = 0.001) were the only independent predictors of cardiac outcomes. The LV myocardial deformation derived from FT CMR was significantly impaired in ARVD/C patients, and this alteration can occur before the impairment of LVEF. LV GLS >−12.65% and history of syncope were the only independent prognostic markers of adverse cardiac outcomes.

Cardiovascular Magnetic Resonance Imaging and Heart Failure

“…A study evaluated the prognostic role of CMR in patients with definite ( n = 52), borderline ( n = 50), and possible ( n = 73) diagnosis of ARVC, and the results showed that LV involvement (fat infiltration and/or LGE) was an independent predictor of cardiac events [ 113 ]. A recent study demonstrated that LV global strains evaluated by CMR feature tracking could detect early LV dysfunction and predict adverse cardiac events in patients with ARVC [ 114 ].…”

Cardiomyopathies in China: A 2018–2019 state‐of‐the‐art review

“… 108 Further, LV global longitudinal strain of >−12.65% is an independent prognostic marker for adverse cardiac outcomes. 109 …”

Clinical Presentation, Cardiac Magnetic Resonance Findings, and Prognosis of Patients with Arrhythmogenic Right Ventricular Cardiomyopathy – An Experience from Pakistan

“…Recent studies have shown that potential LV involvement may develop ahead of significant RV dysfunction in patients with ARVC, although RV dysfunction presents earlier because of its thin and distensible features, which allow it to be primarily affected. [15] One reason for LV involvement in more than half of the patients could be the late presentation and delayed diagnosis due to less awareness and suboptimal medical facilities in this part of the world. is further signifies the importance of this study.…”

“…Recent studies have shown that potential LV involvement may develop ahead of significant RV dysfunction in patients with ARVC, although RV dysfunction presents earlier because of its thin and distensible features, which allow it to be primarily affected. [ 15 ]…”