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

Publication ,  Journal Article
Gilotra, NA; Bhonsale, A; James, CA; Te Riele, ASJ; Murray, B; Tichnell, C; Sawant, A; Ong, CS; Judge, DP; Russell, SD; Calkins, H; Tedford, RJ
Published in: Circ Heart Fail
September 2017

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.

Duke Scholars

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

September 2017

Volume

10

Issue

9

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Risk Factors
  • Retrospective Studies
  • Prevalence
  • Male
  • Magnetic Resonance Imaging, Cine
  • Humans
  • Heart Failure
  • Heart Conduction System
 

Citation

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Gilotra, N. A., Bhonsale, A., James, C. A., Te Riele, A. S. J., Murray, B., Tichnell, C., … Tedford, R. J. (2017). Heart Failure Is Common and Under-Recognized in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Circ Heart Fail, 10(9). https://doi.org/10.1161/CIRCHEARTFAILURE.116.003819
Gilotra, Nisha A., Aditya Bhonsale, Cynthia A. James, Anneline S. J. Te Riele, Brittney Murray, Crystal Tichnell, Abhishek Sawant, et al. “Heart Failure Is Common and Under-Recognized in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia.Circ Heart Fail 10, no. 9 (September 2017). https://doi.org/10.1161/CIRCHEARTFAILURE.116.003819.
Gilotra NA, Bhonsale A, James CA, Te Riele ASJ, Murray B, Tichnell C, et al. Heart Failure Is Common and Under-Recognized in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Circ Heart Fail. 2017 Sep;10(9).
Gilotra, Nisha A., et al. “Heart Failure Is Common and Under-Recognized in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia.Circ Heart Fail, vol. 10, no. 9, Sept. 2017. Pubmed, doi:10.1161/CIRCHEARTFAILURE.116.003819.
Gilotra NA, Bhonsale A, James CA, Te Riele ASJ, Murray B, Tichnell C, Sawant A, Ong CS, Judge DP, Russell SD, Calkins H, Tedford RJ. Heart Failure Is Common and Under-Recognized in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Circ Heart Fail. 2017 Sep;10(9).

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

September 2017

Volume

10

Issue

9

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Risk Factors
  • Retrospective Studies
  • Prevalence
  • Male
  • Magnetic Resonance Imaging, Cine
  • Humans
  • Heart Failure
  • Heart Conduction System