Abstract
Abstract Background Arrhythmogenic cardiomyopathy (AC) is a genetically determined heart muscle disease characterized by myocyte necrosis and consequent fibro-fatty replacement. The recognition of fibrosis is a relevant finding with important diagnostic and prognostic implications. Speckle tracking echocardiography (STE) may be more accurate than conventional echocardiography in detecting early myocardial alterations that need to be confirmed with the gold standard technique, cardiac magnetic resonance (CMR). Purpose The aim of our study is to evaluate if STE-derived strain analysis can predict the presence of fibrosis on CMR in the corresponding segment. Methods 86 patients with AC (including right/left dominant and biventricular forms) underwent advanced echocardiography with STE-derived strain analysis and CMR. Using a 17-segment Bull's-eye model, the cut-off value that best predicts the presence of gadolinium enhancement on CMR was determined for each wall segment using ROC curve analysis. Results The medium age was 45 (32-58) years, male gender was prevalent 71%. Among our patients, 44.1% had a biventricular form, 26.7% had a right-dominant form, 26.7% had a left-dominant form, and 2.3% had a borderline diagnosis. Regarding cardiovascular risk factors, 11.6% of patients had arterial hypertension, 15.1% had dyslipidemia, 2% had diabetes, 1% were smokers and 1% had coronary artery disease with previous percutaneous revascularization. The mean left ventricle (LV) ejection fraction (EF) was preserved 59% (54-64), while the medium LV global longitudinal strain (GLS) was slightly reduced, -18.2% (-20.1 to -15.2). A detailed analysis of regional wall strain was performed, and ROC curve analysis was used to determine a cut-off value for each segment to predict the presence of fibrosis on CMR in the corresponding segment, as shown in Table 1. Lower-than-average values demonstrated good accuracy in predicting the presence of fibrosis on CMR. Conclusions STE-strain analysis is a clinically accessible tool that enhances the sensitivity of echocardiography in detecting myocardial tissue alterations in AC, which would otherwise be identifiable only through CMR. Notably, even when GLS is within normal limits, regional strain sub-analysis can additionally reveal myocardial involvement. Table 1
Published Version
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