P63
VENTRICULAR FUNCTION IN PATIENTS WITH ARRHYTHMOGENIC RIGHT VENTRICULAR
CARDIOMYOPATHY AND IN THEIR RELATIVES: LAYER-SPECIFIC ANALYSIS OF MYOCARDIAL
DEFORMATION BY SPECKLE TRACKING AND 3D ECHO
Roberta Ancona, Salvatore Comenale Pinto, Pio Caso, Maria Gabriella Coppola,
Fortunato Arenga, Antonio D’Onofrio, Vincenzo Sellitto, Raffaele Calabrò
Non invasive Cardiology, Chair of Cardiology, Department of Cardiology, Second University of Naples,
Monaldi Hospital, Napoli
Purpose: We evaluated 2D Strain (S)-Strain rate (SR), 3DE, 3DS, to quantitatively assess RV (right
ventricle), LV (left ventricle) function in ARVC patients (pts), with apparently normal LV and in their
relatives with apparently normal RV.
Methods: We studied 115 subjects: 35 with ARVC (Group A), 40 relatives (Group B) and 40 controls
(Group C). By E9GE we measured LV ejection fraction (EF%), diameters and volumes, RV dimension,
fractional area change (FAC%), RVOT fractional shortening (RVOTfs%). We measured: by DTI annulus
velocities; by 2D Speckle tracking longitudinal systolic 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 circumferential (with endocardial an epicardial layer analysis) and radial peak systolic LV 2D S-SR in short axis
views; by 3DE RV volumes and RVEF; by 3DS peak of global longitudinal, circumferential, radial and
area S in apical 4-chambers.
Results: No significant differences were found between relatives and controls for RV dimensions,
RVFAC (50 ± 12 vs 51 ± 11%), RVOTfs (64.8 ± 13 vs 65.3 ± 14%), 3 DRV end-diastolic (31 ± 10.5
vs 33 ± 11 ml/mq) and end-systolic volume (15 ± 4 vs 16 ± 6 ml/mq), and for RA S-SR. Differences
were present between Group A and C for RV dimensions, 3DRV end-diastolic (52.8 ± 9 ml/mq) and
end-systolic volume (27 ± 6.8 ml/mq), FAC (27.8 ± 12.1%), RVOTfs (27.2 ± 16%), 3D RVEF (49 ±
7.4%. Tricuspidal E’/A’ ratio was inverted in pts and in 32/40 ARVC relatives. RV 2DSR-S were lower
in pts (SR = -1.37 ± 0.37S-1; S = -12.45 ± 4.4%, p < 0.001) and in 28/40 (70%) subjects of Group
B (S = -18.5 ± 4.8%; SR = -1.54 ± 0.4S-1, p < 0.002) compared with controls (S = -26.6 ± 8.1%, SR
= -2.37 ± 0.51 S-1). LV SR-S were significantly lower in Group A compared to controls (longitudinal:
2DSR = -1.01 ± 0.21 vs -1.53 ± 0.49S-1; 2DS = -15.2 ± 4.3% vs -20.59 ± 4.47%, 3DS -12.3 ± 2.3%
vs -19 ± 3.1%; circumferential: 2DSR = -1.18 ± 0.33 vs 1.62 ± 0.4S-1; 2DS = -15.12 ± 3.9 vs -21 ±
5.1%; 3DS -13.8 ± 3.1% vs -15.3 ± 2.6%; radial: 2DSR = 1.19 ± 0.26 vs 1.58 ± 0.3S-1, 2DS = 16.25
± 8.9 vs 46.3 ± 9.2%; 3DS 34.5 ± 6.1% vs 48 ± 9%; 3D area S -23.3 ± 2.9% vs -30.1 ± 3.6%; p <
0.007) without differences for Group B (longitudinal: 2DSR = 1.49 ± 0.45S-1, 2DS = 19.59 ± 4.1%,
3DS -17.7 ± 3.2%; circumferential: 2DSR = -1.59 ± 0.4S-1; 2DS =- 20.8 ± 5%; 3DS -18.8 ± 1.9%;
radial: 2DSR = 1.56 ± 0.29S-1; 2DS = 45.9 ± 9%; 3DS 49 ± 8.1%;3D area S -31 ± 3.1%). The difference in peak systolic circumferential LV 2DS between endocardial and epicardial layer amounted to
34% for group C and to 50% for group A (p > 0.01).
Conclusions: 2DS-SR shows early RV dysfunction in asymptomatic ARVC relatives and LV dysfunction
in ARVC, when standard echo appears normal and a more marked difference in circumferential S
between endocardial and epicardial layer.