A meta-analysis for echocardiographic assessment of right ventricular structure and function in ARVC

M Qasem; V Utomi; K George; J Somauroo; A Zaidi; L Forsythe; S Bhattacharrya; G Lloyd; B Rana; L Ring; S Robinson; R Senior; N Sheikh; M Sitali; J Sandoval; R Steeds; M Stout; J Willis; D Oxborough

doi:10.1530/ERP-16-0028

A meta-analysis for echocardiographic assessment of right ventricular structure and function in ARVC

Echo Res Pract. 2016 Sep 29;3(3):95-104. doi: 10.1530/ERP-16-0028. Online ahead of print.

Authors

M Qasem¹, V Utomi¹, K George¹, J Somauroo¹, A Zaidi¹, L Forsythe¹, S Bhattacharrya¹, G Lloyd¹, B Rana¹, L Ring¹, S Robinson¹, R Senior¹, N Sheikh¹, M Sitali¹, J Sandoval¹, R Steeds¹, M Stout¹, J Willis¹, D Oxborough¹

Affiliation

¹ M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK.

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  SD; 34 vs. 28 mm P<0.001) and RVDarea (23 vs. 18 cm2 P<0.001) compared to 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-1 P<0.001), E' (9 vs. 13 cm.s-1 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.