Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) increases the risk of heart failure (HF) and arrhythmias. While speckle tracking echocardiography (STE) detects myocardial dysfunction, its predictive role for HF in this population remains unclear.
Methods: 71 patients with ARVC (43.7±14.8 years, 53.5% male) without prevalent HF at baseline enrolled in the Johns Hopkins ARVC registry were retrospectively included. Global strain (GS) and strain rate (SR) of the left ventricle (LV), right ventricle free-wall (RVFW), left atrium (LA), and right atrium (RA) were measured by a blinded operator. Cox regression models assessed their association with incident HF.
Results: Incident HF developed in 23 patients (49.3±12.5 years, 52.2% male) during a median follow-up of 2.7 years. Decreases in strain were significantly associated with HF: LVGLS (HR: 1.20, 95% CI: 1.06-1.35, P=0.003), RVFWS (HR: 1.11, 95% CI: 1.04-1.18, P=0.003), LAGS (HR: 1.05, 95% CI: 1.00-1.09, P=0.030) and RAGS (HR: 1.07, 95% CI: 1.03-1.12, P<0.001). Associations for LVGLS, RVFWS and RAGS remained significant after adjusting for age and sex. Strain values frequently fell below established reference ranges. Any strain value (LVGLS, RVFWS, LAGS, or RAGS) below the normal limit was associated with an eightfold increase in HF (HR 8.43, 95% CI 1.97-36.02, P=0.004), while each individual component below the normal threshold doubled the risk (HR 2.35, 95% CI 1.60-3.45, P<0.001).
Conclusions: STE deformation abnormalities are associated with incident HF in ARVC patients. Echocardiographic strain may aid in identifying patients at risk of HF for closer follow-up and management.
Keywords: ARVC; cardiomyopathy; heart failure; speckle tracking echocardiography.
Copyright © 2024. Published by Elsevier Inc.