Presence and prognostic value of ventricular diastolic function in arrhythmogenic right ventricular cardiomyopathy

Abstract

Introduction Limited data exist regarding the presence and importance of diastolic parameters in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). We sought to evaluate RV diastolic parameters and echo‐based diastolic predictors of major adverse cardiovascular events (MACE). Method 48 patients with a definitive diagnosis of ARVC were included and followed for 6‐18 months. A comprehensive standard two‐dimensional (2D) transthoracic echocardiography (TTE) with precise evaluation of systolic and diastolic indices of both ventricles was done. RV isovolumetric relaxation time (IVRT), RV myocardial performance index (MPI), and right atrial (RA) volume were evaluated. Results 48 patients (mean age = 38.5 ± 14 years; 79.2% male) were enrolled. 27.3% had grade I, 68.2% had grade II, and 4.5% had grade III RV diastolic dysfunction. In 12‐month follow‐up, 12 patients (25%, with mean RV3DEF = 24.8 ± 9%) experienced MACE and required hospitalization: ventricular tachyarrhythmia in 7 patients (14.6%), RV clot in 2 subjects (4.2%), and right‐sided failure in 3 cases (6.3%). In logistic regression analysis, tissue Doppler velocity of tricuspid annulus (e' TV) (P = .02, OR = 0.581, CI = 0.368‐0.917), peak E mitral valve (P = .043, OR = 0.95, CI = 0.913‐0.999), tissue Doppler velocity of septal e' (P = .052, OR = 0.733, CI = 0.536‐1.003), and MPI (P = .009, OR = 95, CI = 3.083‐2942) were powerful predictors of MACE. Conclusion In our study, RV diastolic function parameters including e' TV and e′ MV, RA volume and area, and RV MPI were powerful predictors of MACE and may be considered during the baseline and follow‐up of the ARVC patients.

A comparative study on the analysis of hemodynamics in the athlete’s heart

“…Despite high RV and RVOT flow velocities, athletes had lower MKE values both along the whole RV and more specifically in the RVOT regions during both systole and diastole compared to ARVC patients. This finding likely reflects the differences in RV compliance, which is higher in athletes, whereas ARVC patients can develop RV diastolic dysfunction, which imply a negative prognosis 18 .…”

Echocardiography 2020: Toward deciphering the “Rosetta stone” of left ventricular diastolic function

“…It is quite surprising that the other side of the story (RV pathology leading to LV diastolic dysfunction) remains grossly untold. In this special issue, however, Sadeghpour et al 12 have shown that in subjects with arrhythmogenic right ventricular cardiomyopathy, left ventricular diastolic dysfunction could be present.…”

Multimodality imaging in arrhythmogenic cardiomyopathy

“…RA area, LA volume index, RVOT diameter and TAPSE were associated with increased odds of having atrial arrhythmias, even after adjusting for age 13 . In 48 patients with ACM followed for 6-18 months, e' of the tricuspid valve annulus, peak E velocity of the mitral valve, septal e' at the mitral valve, RA area and volume, alongside with right ventricular myocardial performance index were strong predictors for major adverse cardiac events 14 . Moreover, among 64 patients with ACM defi ned by imaging criteria (echocardiography and CMR), as well as genetic testing, lower RV EF and LV EF values were predictive for biventricular involvement.…”