{
  "abstract": "Background In advanced arrhythmogenic right ventricular cardiomyopathy (ARVC), patients face both malignant ventricular arrhythmias (MVA) and end-stage heart failure (HF). The prognostic role of right atrial (RA) function assessed by cardiac MRI (CMR) remains unclear.Methods This cohort study included consecutive ARVC patients who underwent CMR between 2012 and 2021. Demographic, clinical, and CMR-derived strain data were collected. Clinical outcomes were classified into two categories: the end stage HF outcome, comprising cardiovascular mortality–related events (heart failure–related death and heart transplantation), and the MVA outcome, defined as a composite arrhythmic endpoint including sudden cardiac death or aborted SCD, spontaneous sustained ventricular arrhythmias, and appropriate ICD therapy.Results A total of 316 patients (mean age 38 ± 15 years; 66.1% male) were included. Over a median follow-up of 5.3 years, 49 developed end-stage HF and 103 experienced MVA outcomes. Multivariable Cox regression showed that impaired RA reservoir strain was an independent predictor of end-stage HF (HR 0.92, 95% CI 0.89–0.96, p<0.001) and MVA outcomes (sHR 0.98, 95% CI 0.96–0.99, p=0.020), with added prognostic value beyond clinical and imaging variables, achieving the highest C-statistics to 0.84 and 0.70, respectively. Kaplan-Meier survival curves indicated that RA reservoir strain <18.6% was associated with higher end-stage HF risk, consistent across subgroups regardless of left ventricular involvement (all log-rank p<0.001). In Fine-Gray models, RA reservoir strain <23.0% was significantly associated with MVA (p<0.001), but this association was not significant in subgroup with left ventricular involvement (p=0.730).Conclusions RA reservoir strain independently predicts both end-stage HF and MVA events in ARVC, providing incremental prognostic value beyond conventional risk markers. However, in the presence of left ventricular involvement, impaired RA strain is associated with elevated risk of heart failure but not with arrhythmic outcomes.",
  "authors": [
    {
      "affiliations": [
        "Fuwai hospital, Beijing, China. Royal Brompton Hospital, London, United Kingdom"
      ],
      "name": "Wenqing Xu"
    }
  ],
  "title": "21 Risk stratification and outcomes of right atrial phasic function in arrhythmogenic right ventricular cardiomyopathy: a cardiac MRI study",
  "uid": "8d6c1815-934a-57d8-bf05-8831a42068ff"
}