Progression of myocardial dysfunction and prediction of arrhythmic events in patients with exercise-induced arrhythmogenic cardiomyopathy

Linda T. Aaserud, MD; Christine Rootwelt-Norberg, MD, PhD; Christian K. Five, MD; Eivind W. Aabel, MD, PhD; Nina E. Hasselberg, MD, PhD; Erik Lyseggen, MD, PhD; Kristina H. Haugaa, MD, PhD; Øyvind H. Lie, MD, PhD

Heart Rhythm O2 (Oct 2024)

Progression of myocardial dysfunction and prediction of arrhythmic events in patients with exercise-induced arrhythmogenic cardiomyopathy

Linda T. Aaserud, MD,
Christine Rootwelt-Norberg, MD, PhD,
Christian K. Five, MD,
Eivind W. Aabel, MD, PhD,
Nina E. Hasselberg, MD, PhD,
Erik Lyseggen, MD, PhD,
Kristina H. Haugaa, MD, PhD,
Øyvind H. Lie, MD, PhD

Affiliations

Linda T. Aaserud, MD: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Christine Rootwelt-Norberg, MD, PhD: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Christian K. Five, MD: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Eivind W. Aabel, MD, PhD: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Nina E. Hasselberg, MD, PhD: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Erik Lyseggen, MD, PhD: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Kristina H. Haugaa, MD, PhD: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Øyvind H. Lie, MD, PhD: Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Address reprint requests and correspondence: Dr Øyvind H. Lie, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway.

Journal volume & issue: Vol. 5, no. 10
pp. 705 – 712

Abstract

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Background: Several reports exist of an acquired exercise-induced arrhythmogenic cardiomyopathy. Little is known about myocardial disease progression and arrhythmia prediction in this population. Objective: The study sought to explore the evolution of myocardial function and structure and its relation to incident life-threatening ventricular arrhythmias (VA), to identify markers of impending events. Methods: We included athletes (individuals with exercise doses >24 metabolic equivalent of task hours per week, >6 consecutive years, participating in organized and competitive sports) who had VA, absence of family history and known genetic variants associated with cardiac disease, and no other identified etiology, in a tertiary referral single-center, longitudinal cohort study of patients with exercise-induced arrhythmogenic cardiomyopathy (EiAC). Evolution of myocardial function and structure was assessed by repeated echocardiographic examinations during long-term follow-up. Life-threatening VA were assessed at baseline and during long-term follow-up. Results: Forty-one EiAC patients (15% women, age 45 ± 13 years) were followed for 80 (interquartile range 48–115) months. There were no changes in myocardial function or structure in the overall population during follow-up. We observed high incidence rate and high recurrence rate of life-threatening VA in EiAC patients. Subtle deterioration of right ventricular function was strongly associated with subsequent first-time VA (odds ratio 1.12, 95% confidence interval 1.01–1.25, P = .031, per 1% deterioration of right ventricular free wall longitudinal strain). Conclusion: There were no clear changes in myocardial function or structure during follow-up in the overall population, but there was a high incidence rate and high recurrence rate of life-threatening VA. Subtle right ventricular deterioration by free wall longitudinal strain was a strong predictor of impending first-time life-threatening VA during follow-up.

Published in Heart Rhythm O2

ISSN: 2666-5018 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/heart-rhythm-o2

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