P311New findings about ventricular and atrial function assessed by Speckle Tracking and 3D echocardiography in arrhythmogenic right ventricular cardiomyopathy (ARVC)

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Purpose: The evolution of ARVC is more diffuse right ventricle (RV) involvement and, sometimes, left ventricular(LV) abnormalities, that may result in heart failure. We evaluated the potential utility of two-dimensional (2D) Strain-Strain rate (S-SR) and 3D echocardiography to quantitatively assess RV, LV and atrial function in ARVC patients (pts), with apparently normal LV.Methods: we studied 70 subjects: 35 pts with ARVC and 35 healthy controls. By E9GE we measured LV ejection fraction (EF%), LV diameters and volumes, RV dimension (apex, outflow tract and infero-basal segment, near tricuspidal valve), fractional area change (FAC%), RVOT fractional shortening (RVOTfs%), RA volume. By DTI we measured velocity of early (E') and late (A') diastolic and systolic wave (S) at level of tricuspidal annulus. We measured 2D longitudinal systolic ventricular and atrial S-SR in apical 4 and 2-chambers views, at level of LV segments (4 basal,4 mid,4 apical), RV segments (1 basal,1 mid,1apical) and atrial walls and circonferential and radial peak systolic LV 2D S-SR in short axis views. By 3D echocardiography with volumetric probe we measured RA, RV volumes and RV EF.Results: RV dimension, 3D RV end-diastolic (52,8±9vs33±11ml/mq) and end-systolic volume (27±6,8vs16±6ml/mq) were higher in all pts than controls; FAC (27,8±12,1%), RVOTfs (27,2±16%) and 3D RVEF (49±7,4vs67±8%) were lower. While 2D RA volume were higher in pts (52,8±20vs37±7,5ml;index:25,6±10,4vs18,7±6ml/mq), no significant differences were found for 3D RA volume (56,4±13vs±51±13ml;index 27,9±5vs28±10ml/mq). At TVI of tricuspidal valve ratio E'/A' was=0,73 in pts vs 1,2 in controls. RV systolic 2D SR-S were significantly lower in pts compared with controls (SR= -1,37 ±0,37 vs -2,37±0,51 S-1,p < 0.001;S=-12,45±4,4% vs -26,6±8,1%, p< 0.001). Also LV 2D SR(longitudinal: -1,01±0,21 vs -1,53 ±0,49 S-1; circumferential: -1,18±0,33 vs -1,62±0,4 S-1; radial: 1,19±0,26 vs 1,58 ± 0,3 S-1, p < 0.003), and LV 2D S (longitudinal: -15,2±4,3 % vs -20,59 ±4,47%, circumferential: -15,12±3,9 vs -21 ± 5,1%; radial: 16,25 ± 8,9 vs 46,3±9,2%, p< 0.003) were significantly lower in pts, even if LV diameters, LVEF and 3D LV volumes and 3D EF were normal. RV systolic 2D S (-18,5±4,8%, p < 0.002) and SR (-1,54±0,4, p< 0.002) and RA systolic 2D S-SR were significantly lower in ARVC pts than in controls.Conclusions: RV 2D S-SR and 3D RVEF were significantly lower in ARVC pts compared with controls. 2D S-SR enables to show early LV dysfunction in these pts, when standard echocardiography doesn't show any impairment.

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