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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 February 2025 issue of Cardiology by Chua et al.
Arrhythmogenic right ventricular cardiomyopathy is traditionally considered a right ventricular disease, though left ventricular involvement has increasingly been recognized. The diagnosis of ARVC is typically based on the 2010 Task Force Criteria, which emphasizes RV assessment through routine echocardiography. However, previous research suggests that strain imaging, which can assess both RV and LV function, may offer higher sensitivity for detecting dysfunction in both ventricles. Despite this, there is a lack of data on the additional prognostic value of incorporating biventricular strain in risk stratification for ARVC.
This study aimed to evaluate the prognostic significance of global longitudinal strain for the LV and free wall strain for the RV in patients with ARVC. A total of 204 patients meeting the TFC for ARVC (mean age 41 ± 17 years, 55% male) were included. These patients were divided into three groups based on strain values: impaired strain (n = 33), discordant strain (impaired RV or LV, n = 70), and normal strain (n = 101), using a threshold of ≥18% for both ventricles. Over a median follow-up of 87 months (range 24–136 months), 57 patients (28%) experienced adverse events, including all-cause mortality, arrhythmic events, ICD therapy, and heart failure.
A significant difference in event-free survival was observed across the three strain groups (p < 0.001). In multivariable analysis, strain groups remained predictive of adverse outcomes (p = 0.014) after adjusting for age, sex, syncope history, and confirmed ARVC diagnosis. Further sub-analysis of patients with definite or borderline ARVC diagnoses reaffirmed the independent prognostic value of strain (p = 0.023). In conclusion, combining biventricular strain analysis could provide valuable risk stratification in ARVC, with the poorest outcomes observed in patients with impaired strain in both the RV and LV.
Source: sciencedirect.com/science/article/pii/S0002914925000141