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Prognostic value of right ventricular trabecular complexity in patients with arrhythmogenic cardiomyopathy

  • Cardiac
  • Published:
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Abstract

Objectives

The present study aimed to investigate the incremental prognostic value of the right ventricular fractal dimension (FD), a novel marker of myocardial trabecular complexity by cardiac magnetic resonance (CMR) in patients with arrhythmogenic cardiomyopathy (ACM).

Methods

Consecutive patients with ACM undergoing CMR were followed up for major cardiac events, including sudden cardiac death, aborted cardiac arrest, and appropriate implantable cardioverter defibrillator intervention. Prognosis prediction was compared by Cox regression analysis. We established a multivariable model supplemented with RV FD and evaluated its discrimination by Harrell’s C-statistic. We compared the category-free, continuous net reclassification improvement (cNRI) and integrated discrimination index (IDI) before and after the addition of FD.

Results

A total of 105 patients were prospectively included from three centers and followed up for a median of 60 (48, 66) months; experienced 36 major cardiac events were recorded. Trabecular FD displayed a strong unadjusted association with major cardiac events (p < 0.05). In the multivariable Cox regression analysis, RV maximal apical FD maintained an independent association with major cardiac events (hazard ratio, 1.31 (1.11–1.55), p < 0.002). The Hosmer–Lemeshow goodness of fit test displayed good fit (X2 = 0.68, p = 0.99). Diagnostic performance was significantly improved after the addition of RV maximal apical FD to the multivariable baseline model, and the continuous net reclassification improvement increased 21% (p = 0.001), and the integrated discrimination index improved 16% (p = 0.045).

Conclusions

In patients with ACM, CMR-assessed myocardial trabecular complexity was independently correlated with adverse cardiovascular events and provided incremental prognostic value.

Clinical relevance statement

The application of FD values for assessing RV myocardial trabeculae may become an accessible and promising parameter in monitoring and early diagnosis of risk factors for adverse cardiovascular events in patients with ACM.

Key Points

• Ventricular trabecular morphology, a novel quantitative marker by CMR, has been explored for the first time to determine the severity of ACM.

• Patients with higher maximal apical fractal dimension of RV displayed significantly higher cumulative incidence of major cardiac events.

• RV maximal apical FD was independently associated with major cardiac events and provided incremental prognostic value in patients with ACM.

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Abbreviations

ACM:

Arrhythmogenic cardiomyopathy

ALVC:

Arrhythmogenic left ventricular cardiomyopathy

ARVC:

Arrhythmogenic right ventricular cardiomyopathy

ARVD:

Arrhythmogenic right ventricular dysplasia

DSG2:

Desmoglein-2

DSP:

Desmoplakin

FD:

Fractal dimension

NSVT:

Non-sustained ventricular tachycardia

PKP2:

Plakophilin-2 gene

PVC:

Premature ventricular complex

TFC:

Task Force Criteria

TWI:

Inverted T-wave

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Funding

Supported by the National Natural Science Foundation of China (No. 82171884); and Shanghai Jiao Tong University Medical Engineering Cross Project (No. YG2022QN016).

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Author notes

  1. Bing-Hua Chen, Wen-Yi Jiang, and Jin-Yu Zheng contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, People’s Republic of China

    Bing-Hua Chen, Wen-Yi Jiang, Jin-Yu Zheng, Yi-Si Dai, Ruo-Yang Shi, Rui Wu, Dong-Aolei An, Jian-Rong Xu & Lian-Ming Wu

  2. Department of Radiology, Longyan First Hospital, Affiliated to Fujian Medical University, Longyan, 364000, People’s Republic of China

    Lang-Lang Tang

  3. Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, People’s Republic of China

    Lei Zhao

Authors
  1. Bing-Hua Chen
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Corresponding authors

Correspondence to Lei Zhao or Lian-Ming Wu.

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Guarantor

The scientific guarantor of this publication is Lian-Ming Wu.

Conflict of interest

The authors state that there neither exists a conflict of interest nor that there is financial information to disclose.

Statistics and biometry

Lian-Ming Wu kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all participants in this study.

Ethical approval

Institutional Review Board approval was obtained. The CMR study protocol was approved by each of the institutional ethics committees (Shanghai Renji Hospital, Beijing Anzhen Hospital, and Fujian Longyan First Hospital) and was conducted according to the Declaration of Helsinki.

Study subjects or cohorts overlap

Study subjects or cohorts have not been previously reported.

Methodology

• prospective

• observational

• multicenter study

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Chen, BH., Jiang, WY., Zheng, JY. et al. Prognostic value of right ventricular trabecular complexity in patients with arrhythmogenic cardiomyopathy. Eur Radiol (2024). https://doi.org/10.1007/s00330-023-10561-y

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