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The following is a summary of “Arrhythmogenic Right Ventricular Cardiomyopathy: the importance of biventricular strain in risk-stratification,” published in the January 2025 issue of Cardiology by Chua et al. 

Arrhythmogenic right ventricular cardiomyopathy (ARVC), primarily a right ventricular (RV) disease, left ventricular (LV) involvement was recognized, and previous studies suggested strain imaging might be more sensitive for detecting dysfunction, though the added value of biventricular strain for risk stratification remained unclear.  

Researchers conducted a retrospective study to evaluate the prognostic value of both LV global longitudinal strain (GLS) and RV free wall strain (FWLS) in patients with ARVC.  

They included 204 patients (age 41±17 years, 55% male) who met the Task Force Criteria (TFC) for the ARVC spectrum. The patients were classified into 3 strain groups: impaired (n=33), discordant (RV or LV impaired, n=70), and normal (n=101), based on a threshold value of ≥18% for both ventricles.  

The results showed that, during a follow-up of 87 (24-136) months, 57 (28%) patients experienced the composite outcome of all-cause mortality, arrhythmic events, implantable cardioverter defibrillator therapy, and heart failure events. A significant difference in event-free survival was observed (P <0.001) between the 3 groups. In multivariable analysis, strain groups remained associated with outcomes (P =0.014) after adjusting for age, sex, syncope history, and definite ARVC diagnosis. A sub-analysis of definite and borderline diagnosed ARVC confirmed that strain groups independently predicted the endpoint (P =0.023).  

Investigators concluded the biventricular strain analysis might contribute to improved risk stratification in patients with ARVC, with the most adverse outcomes observed in individuals exhibiting impaired strain in both the RV and LV. 

Source: ajconline.org/article/S0002-9149(25)00014-1/fulltext