Risk Factors Associated with Heart Failure in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy

Abstract

Heart failure（HF）is a major cause of death in arrhythmogenic right ventricular cardiomyopathy（ARVC）. The purpose of this study was to elucidate the clinical impact and risk factors of HF in patients with ARVC. We evaluated cardiac adverse outcomes including HF in 113 consecutive patients with ARVC（85 men, mean age : 44±15 years）. During a median follow-up of 10.0 years（interquartile range : 5.2 to 15.7 years）, 29 patients（26％）were hospitalized for progressive HF. Patients with one or more episodes of HF hospitalization had about a 10-fold increased incidence of cardiac death（48％ vs. 4.7％, p＜0.0001）. Left ventricular ejection fraction（LVEF）and right ventricular ejection fraction（RVEF）were significantly lower in patients with HF hospitalization than in patients without HF hospitalization（LVEF, 45±15 vs. 54±13％, p=0.001 ; RVEF, 26±10 vs. 33±11％, p=0.003, respectively）. Regarding the ECG findings, the prevalence of first-degree atrioventricular block（AVB）and epsilon waves were significantly higher in patients with HF hospitalization than in those without HF hospitalization（first-degree AVB, 48％ vs. 13％, p＜0.0001 ; epsilon waves, 34％ vs. 14％, p=0.02）. In multivariate analysis, first-degree AVB at baseline was the strongest independent risk factor for HF hospitalization in patients with ARVC（hazard ratio 4.24, p=0.0011）. In conclusion, HF hospitalization has a significant relation with malignant clinical course in ARVC patients.