Oral session II

Purpose: Arrhythmogenic right ventricular dysplasia (ARVD) is a genetic cardiomyopathycharacterized by fibrofatty replacement of right ventricular (RV) myocardiumleading to progressive RV failure and ventricular arrhythmias in young athletes. Rightventricular features predominate, but left ventricular (LV) involvement can also arisewith disease progression. Our purpose was to evaluate the potential utility of tissueDoppler imaging (TDI) and speckle tracking imaging (STI) to quantitatively assessRV function and their potential role in diagnosing ARVD.Methods: We studied 15 patients with ARVD (diagnosed by task force criteria) and 15healthy age- and sex-matched subjects. RV internal diameters, outflow tract diameter,fractional area change and tricuspid annular systolic excursion were determined bytransthoracic echocardiography. RV and LV annular peak systolic velocities (S) weremeasured by TDI. RV and LV peak systolic strain (e), peak systolic strain rate (SR-S),and early (SR-E) and late (SR-A) diastolic strain rate were obtained in the basal, midand apical segments in apical 4-chamber view both by TDI and STI. Averaged LVrotation and rotational velocities from the base and apex were also obtained by STIand used for calculation of LV torsion. All measurements were taken from an acceptabletracing and determined using offline analysis programs (EchoPAC, version 7.0, GEUltrasound).Results: Inter- and intraobserver correlation was high. STI-e (all segments pooled:210.1+3.2% vs 228+7.1%, p,.001), TDI-e (210.5+4.2% vs 229+9.4%,p,.001), STI-SR-S (20.95+0.41 vs 21.62+0.92 s21, p,.005), TDI-SR-S(21.07+0.47 vs 21.74+0.82 s21, p,.005), STI-SR-E (1.63+0.52 vs 2.13+0.94s21, p,.005), and TDI-SR-E (1.71+0.73 vs 2.34+1.15 s21, p,.005) were significantlylower in patients with ARVD compared with controls, even in the subset ofpatients with apparently normal RV by conventional echocardiography. In 3/15 patientsLV strain and torsion were significantly lower compared with controls (p,.005). ROCcurves suggested that the thresholds offering an adequate compromise between sensitivityand specificity for detection of ARVD were -20% for RV STI-e (AUC 0.86), 223%for RV TDI-e (AUC 0.81), 27.0 cm/sec for RV TDI-S velocity (AUC 0.77), 20.64 sec-1 forRV STI-SR-S (AUC 0.75), and 20.69 sec21 for RV TDI-SR-S (AUC 0.71).Conclusions: Both TDI and STI enable quantitative assessment of RV function anddetection of ARVD and may have potential clinical value in the management of patientswith suspected ARVD complementing and providing incremental information to conventionalechocardiography