Heart Failure Is Common and Under-Recognized in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. (September 2017)

• Record Type: Journal Article
• Authors: Gilotra, Nisha A.; Bhonsale, Aditya; James, Cynthia A.; te Riele, Anneline S.J.; Murray, Brittney; Tichnell, Crystal; Sawant, Abhishek; Ong, Chin Siang; Judge, Daniel P.; Russell, Stuart D.; Calkins, Hugh; Tedford, Ryan J.
• Is Part Of: Circulation. Volume 10:Number 9(2017)
• Publication Date: 2017-09
• Subjects: arrhythmias, cardiac -- cardiomyopathies -- dyspnea -- fatigue -- heart failure; Heart failure -- Periodicals; 616.129005
• DOI: 10.1161/CIRCHEARTFAILURE.116.003819
• Languages: English
• ISSNs: 1941-3289

Abstract

Abstract : Background: Heart failure (HF) prevalence in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) varies depending on study cohort and is not well characterized. This study sought to determine prevalence and predictors of HF in ARVC/D. Methods and Results: Clinical HF, defined as at least 1 HF sign or symptom, was retrospectively adjudicated for 289 patients meeting ARVC/D Task Force Criteria. HF was present in 142 patients (49%): 113 had isolated RV involvement and 29 had evidence of LV dysfunction. Average age of HF onset was 40±14 years. Most commonly reported symptoms were exertional dyspnea (78%) and fatigue (73%). Only 40% (n=57/142) had signs of volume overload. Left-sided HF signs were rare. Patients with clinical HF before ARVC/D diagnosis (n=31) were older ( P =0.005) and met fewer Task Force Criteria ( P =0.013) than those who developed HF after ARVC/D presentation. Female sex (odds ratio, 2.2; 95% confidence interval, 1.21–4.01; P =0.01) and lateral precordial T-wave inversions (odds ratio, 9.87; 95% confidence interval, 1.07–91.1; P =0.043) were associated with increased odds of HF. Additionally, patients with symptomatic LV dysfunction had higher odds of lateral precordial T-wave inversions (odds ratio, 18.4; 95% confidence interval, 2.92–116.18; P =0.002). Patients with HF were more likely to undergo heart transplantation (15/142 versus 1/147; P <0.001) or die during study follow-up period (7 versus 0; P =0.007). Conclusions: HF symptoms, especially exertional dyspnea, are common in ARVC/D; yet, classic left-sided signs are typically absent and less than half have evidence of volume overload. Given the unique predominately right-sided phenotype, a large portion of patients with HF may be under-recognized. Abstract : Supplemental Digital Content is available in the text.