Different Prognostic Value of Functional Right Ventricular Parameters in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

Saguner, Ardan Muammer; Vecchiati, Alessandra; Baldinger, Samuel Hannes; Rüeger, Sina; Medeiros Domingo, Argelia; Mueller-Burri, Andreas S.; Haegeli, Laurent M; Biaggi, Patric; Manka, Robert; Lüscher, Thomas F.; Fontaine, Guy; Delacrétaz, Etienne; Jenni, Rolf; Held, Leonhard; Brunckhorst, Corinna; Duru, Firat; Tanner, Felix C. (2014). Different Prognostic Value of Functional Right Ventricular Parameters in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Circulation. Cardiovascular Imaging, 7(2), pp. 230-239. Lippincott Williams & Wilkins 10.1161/CIRCIMAGING.113.000210

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BACKGROUND -The value of standard two-dimensional transthoracic echocardiographic (TTE) parameters for risk stratification in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is controversial. METHODS AND RESULTS -We investigated the impact of right ventricular fractional area change (FAC) and tricuspid annulus plane systolic excursion (TAPSE) for prediction of major adverse cardiovascular events (MACE) defined as the occurrence of cardiac death, heart transplantation, survived sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia or arrhythmogenic syncope. Among 70 patients who fulfilled the 2010 ARVC/D Task Force Criteria and underwent baseline TTE, 37 (53%) patients experienced a MACE during a median follow-up period of 5.3 (IQR 1.8-9.8) years. Average values for FAC, TAPSE, and TAPSE indexed to body surface area (BSA) decreased over time (p=0.03 for FAC, p=0.03 for TAPSE and p=0.01 for TAPSE/BSA, each vs. baseline). In contrast, median right ventricular end-diastolic area (RVEDA) increased (p=0.001 vs. baseline). Based on the results of Kaplan-Meier estimates, the time between baseline TTE and experiencing MACE was significantly shorter for patients with FAC <23% (p<0.001), TAPSE <17mm (p=0.02) or right atrial (RA) short axis/BSA ≥25mm/m(2) (p=0.04) at baseline. A reduced FAC constituted the strongest predictor of MACE (hazard ratio 1.08 per 1% decrease; 95% confidence interval 1.04-1.12; p<0.001) on bivariable analysis. CONCLUSIONS -This long-term observational study indicates that TAPSE and dilation of right-sided cardiac chambers are associated with an increased risk for MACE in ARVC/D patients with advanced disease and a high risk for adverse events. However, FAC is the strongest echocardiographic predictor of adverse outcome in these patients. Our data advocate a role for TTE in risk stratification in patients with ARVC/D, although our results may not be generalizable to lower risk ARVC/D cohorts.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Saguner, Ardan Muammer; Baldinger, Samuel Hannes; Medeiros Domingo, Argelia and Delacrétaz, Etienne

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1942-0080

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Argelia Medeiros Domingo

Date Deposited:

06 Jun 2014 10:51

Last Modified:

29 Oct 2015 12:58

Publisher DOI:

10.1161/CIRCIMAGING.113.000210

PubMed ID:

24515411

Uncontrolled Keywords:

arrhythmogenic right ventricular cardiomyopathy dysplasia echocardiography outcome systolic function

BORIS DOI:

10.7892/boris.42240

URI:

https://boris.unibe.ch/id/eprint/42240

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