PDF(Pubmed)
Abstract：
BACKGROUND: Strain analysis is a sensitive method for the assessment of ventricular structural or functional alterations. The authors aimed to determine whether right ventricular (RV) strain parameters can discriminate patients with revised Task Force Criteria-diagnosed arrhythmogenic RV cardiomyopathy (ARVC) incremental to the existing cardiovascular magnetic resonance (CMR) criteria, thus improving the diagnostic yield of CMR in ARVC.
RESULTS: A total of 74 patients with revised Task Force Criteria-diagnosed ARVC (37 borderline and 37 definite) and 37 controls were retrospectively enrolled for analysis. Using CMR feature tracking, RV global longitudinal (GLS), circumferential, and radial strain of all participants were evaluated. Compared with controls, the study patients demonstrated significantly impaired global biventricular strain in all 3 directions (all P<0.001). Receiver operating characteristic curve analysis indicated that RV GLS was the strongest discriminator among all RV strain parameters for the identification of patients with ARVC (area under the curve, 0.92). Using the Youden index, the authors determined RV GLS ≥-19.95% as the diagnostic criterion of ARVC. In patients diagnosed with borderline ARVC according to revised Task Force Criteria but with no or only minor CMR criteria, there were >50% presenting with impaired RV GLS. When both conventional criteria and RV GLS were considered together, this new diagnostic method demonstrated an overall diagnostic accuracy of 90%. The likelihood ratio test showed a significant incremental diagnostic value of RV GLS (P=0.02) over the existing CMR major criteria.
CONCLUSIONS: The current study showed an improved diagnostic accuracy when both RV GLS and the existing CMR criteria were considered together, especially for patients with borderline diagnosis, suggesting the incremental value of strain analysis to the initial assessment of ARVC.
RESULTS: A total of 74 patients with revised Task Force Criteria-diagnosed ARVC (37 borderline and 37 definite) and 37 controls were retrospectively enrolled for analysis. Using CMR feature tracking, RV global longitudinal (GLS), circumferential, and radial strain of all participants were evaluated. Compared with controls, the study patients demonstrated significantly impaired global biventricular strain in all 3 directions (all P<0.001). Receiver operating characteristic curve analysis indicated that RV GLS was the strongest discriminator among all RV strain parameters for the identification of patients with ARVC (area under the curve, 0.92). Using the Youden index, the authors determined RV GLS ≥-19.95% as the diagnostic criterion of ARVC. In patients diagnosed with borderline ARVC according to revised Task Force Criteria but with no or only minor CMR criteria, there were >50% presenting with impaired RV GLS. When both conventional criteria and RV GLS were considered together, this new diagnostic method demonstrated an overall diagnostic accuracy of 90%. The likelihood ratio test showed a significant incremental diagnostic value of RV GLS (P=0.02) over the existing CMR major criteria.
CONCLUSIONS: The current study showed an improved diagnostic accuracy when both RV GLS and the existing CMR criteria were considered together, especially for patients with borderline diagnosis, suggesting the incremental value of strain analysis to the initial assessment of ARVC.
摘要：
背景：应变分析是一种评估心室结构或功能改变的敏感方法。作者旨在确定右心室（RV）应变参数是否可以区分修订的工作组标准诊断的心律失常性RV心肌病（ARVC）递增到现有的心血管磁共振（CMR）标准的患者。从而提高ARVC中CMR的诊断率。
结果：共有74例修订的工作队标准诊断为ARVC的患者（37例临界和37例明确）和37例对照进行回顾性分析。使用CMR特征跟踪，RV全局纵向（GLS），圆周,评估所有参与者的径向应变。与对照组相比，研究患者在所有3个方向表现出明显的整体双心室劳损受损(均P<0.001).受试者工作特征曲线分析表明，RVGLS是所有RV应变参数中用于识别ARVC患者的最强鉴别器（曲线下面积，0.92)。使用Youden索引，作者确定RVGLS≥-19.95%为ARVC的诊断标准。在根据修订的工作组标准诊断为临界ARVC但没有或仅有次要CMR标准的患者中，>50%的患者表现为RVGLS受损。当常规标准和RVGLS一起考虑时，这种新的诊断方法显示了90%的总体诊断准确率.似然比检验显示RVGLS（P=0.02）相对于现有的CMR主要标准有显著的增量诊断价值。
结论：当前的研究表明，当同时考虑RVGLS和现有CMR标准时，诊断准确性有所提高。特别是对于有临界诊断的患者，表明应变分析对ARVC初始评估的增量价值。
结果：共有74例修订的工作队标准诊断为ARVC的患者（37例临界和37例明确）和37例对照进行回顾性分析。使用CMR特征跟踪，RV全局纵向（GLS），圆周,评估所有参与者的径向应变。与对照组相比，研究患者在所有3个方向表现出明显的整体双心室劳损受损(均P<0.001).受试者工作特征曲线分析表明，RVGLS是所有RV应变参数中用于识别ARVC患者的最强鉴别器（曲线下面积，0.92)。使用Youden索引，作者确定RVGLS≥-19.95%为ARVC的诊断标准。在根据修订的工作组标准诊断为临界ARVC但没有或仅有次要CMR标准的患者中，>50%的患者表现为RVGLS受损。当常规标准和RVGLS一起考虑时，这种新的诊断方法显示了90%的总体诊断准确率.似然比检验显示RVGLS（P=0.02）相对于现有的CMR主要标准有显著的增量诊断价值。
结论：当前的研究表明，当同时考虑RVGLS和现有CMR标准时，诊断准确性有所提高。特别是对于有临界诊断的患者，表明应变分析对ARVC初始评估的增量价值。
