Arrhythmic Risk Prediction in ARVC | 171 Figure 2. Kaplan-Meier estimate of ventricular arrhythmia (VA) free survival for patients with arrhythmogenic right ventricular cardiomyopathy without prior sustained VA Dotted line represents cumulative 5-year survival. Deformation imaging and incidence of VA One patient was excluded because of insufficient image quality for any deformation analyses. Of included patients, LV deformation imaging was feasible in 146 patients (97%) and RV deformation imaging in 148 patients (99%). For the LV deformation parameters, LV GLS was worse in patients who later experienced VA, while LVMD was not (Table 1). All three RV deformation parameters (RVFWLS, RVMD and RV deformation pattern) were more abnormal in patients with VA during follow-up. Regional RV deformation patterns were abnormal (i.e. type II or type III) at baseline in 94% of patients with VA anytime during follow-up against 56% in patients without VA. Moreover, all patients who experienced the primary outcome within 5 years from the echocardiographic assessment had abnormal RV deformation patterns at baseline. Nevertheless, the positive predictive value of an abnormal RV deformation pattern for VA within 5 years was low with 0.41 (95% CI 0.32 – 0.50). The worst outcome was seen in patients with the most abnormal type III deformation pattern (Figure 3, panel B). For the Kaplan-Meier plot of RVFWLS (Figure 3, panel A), threshold regression analysis identified two optimal cut-offs for increased arrhythmic risk (-24% and -17%). Univariable survival analysis showed increased hazard of VA occurrence for all tested deformation parameters, as expressed by hazard ratios (Table 2). 8
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