A meta-analysis for the echocardiographic assessment of right ventricular structure and function in ARVC: a Study by the Research and Audit Committee of the British Society of Echocardiography

Abstract

IntroductionArrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited pathology that can increase the risk of sudden death. Current task force criteria for echocardiographic diagnosis do not include new, regional assessment tools which may be relevant in a phenotypically diverse disease. We adopted a systematic review and meta-analysis approach to highlight echocardiographic indices that differentiated ARVC patients and healthy controls.MethodsData was extracted and analysed from prospective trials that employed a case–control design meeting strict inclusion and exclusion as well as a priori quality criteria. Structural indices included proximal RV outflow tract (RVOT1) and RV diastolic area (RVDarea). Functional indices included RV fractional area change (RVFAC), tricuspid annular systolic excursion (TAPSE), peak systolic and early diastolic myocardial velocities (S′ and E′, respectively) and myocardial strain.ResultsPatients with ARVC had larger RVOT1 (mean ± s.d.; 34 vs 28 mm, P < 0.001) and RVDarea (23 vs 18 cm2, P < 0.001) compared with healthy controls. ARVC patients also had lower RVFAC (38 vs 46%, P < 0.001), TAPSE (17 vs 23 mm, P < 0.001), S′ (9 vs 12 cm/s, P < 0.001), E′ (9 vs 13 cm/s, P < 0.001) and myocardial strain (−17 vs −30%, P < 0.001).ConclusionThe data from this meta-analysis support current task force criteria for the diagnosis of ARVC. In addition, other RV measures that reflect the complex geometry and function in ARVC clearly differentiated between ARVC and healthy controls and may provide additional diagnostic and management value. We recommend that future working groups consider this data when proposing new/revised criteria for the echocardiographic diagnosis of ARVC.

The right heart of the elite senior rugby football league athlete

“…35 The current study reports no difference in TAPSE, RVFAC, or standard indices of TDI between RFL athletes and controls, and therefore, the presence of abnormal values should prompt further investigation. 35 The current study reports no difference in TAPSE, RVFAC, or standard indices of TDI between RFL athletes and controls, and therefore, the presence of abnormal values should prompt further investigation.…”

“…10 It is considered best practice to apply a multifactorial approach to functional assessment including the use of TAPSE, RVFAC, and RV TDI. 35 The current study reports no difference in TAPSE, RVFAC, or standard indices of TDI between RFL athletes and controls, and therefore, the presence of abnormal values should prompt further investigation.…”

Athletic Training and Arrhythmogenic Right Ventricular Cardiomyopathy

“…Both Yoerger et al [57] and Vitarelli et al [55] reported that RV strain has the highest sensitivity and specificity for the diagnosis of ARVC. There were no ARVC patients demonstrating a peak RV strain above − 21 %; that is, much lower than the currently accepted normal RV strain of − 28 % [45] (▶Fig. 1).…”

Speckle Tracking Echocardiography for the Assessment of the Athlete’s Heart: Is It Ready for Daily Practice?

“…Compared to the LV, there are limited RV STE studies in athletes and there is a lack of universally accepted cut-off values [ 25 ••]. A recent and large meta-analysis of RV structure and function in ARVC [ 67 ] concluded that RV ɛ is significantly lower in ARVC patients compared to controls with a range of RV ɛ in controls of − 27 to − 31% and in ARVC patients of − 13 to − 21%. A cut-off for pathology of less than − 21% was therefore suggested.…”