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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

Echo Research & Practice volume 3, pages 95–104 (2016)Cite this article

Abstract

Introduction: Arrhythmogenic 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.

Methods: Data 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.

Results: Patients 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).

Conclusion: The 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.

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Authors and Affiliations

  1. Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK

    Mohammad Qasem, Victor Utomi, Keith George, John Somauroo, Lynsey Forsythe & David Oxborough

  2. Countess of Chester Hospital, NHS Trust, Chester, UK

    John Somauroo

  3. Barts Heart Centre, St Bartholomew’s Hospital, London, UK

    Abbas Zaidi, Sanjeev Bhattacharrya & Guy Lloyd

  4. Papworth Hospital NHS Trust, Cambridge, UK

    Bushra Rana & Shaun Robinson

  5. West Suffolk NHS Trust, Bury St Edmonds, UK

    Liam Ring

  6. National Heart and Lung Institute, Imperial College, London, UK

    Roxy Senior

  7. St Georges University Hospital, UK

    Nabeel Sheikh

  8. Guys and St Thomas’s NHS Trust, London, UK

    Mushemi Sitali

  9. Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Julie Sandoval

  10. University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK

    Richard Steeds

  11. Department of Cardiology, University Hospital of South Manchester, Manchester, UK

    Martin Stout

  12. Royal United Hospital, Bath, UK

    James Willis

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  1. Mohammad Qasem
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Qasem, M., Utomi, V., George, K. et al. 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. Echo Res Pract 3, 95–104 (2016). https://doi.org/10.1530/ERP-16-0028

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