Incremental prognostic value of hepatic tissue alterations derived from cardiac magnetic resonance imaging for arrhythmogenic right ventricular cardiomyopathy: a case-control study

Background: Hepatic injury occurs in patients with cardiovascular disease and is associated with adverse clinical outcomes. The prognostic value of hepatic tissue alterations in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) remains unclear. We aimed to evaluate the incremental prognostic value of hepatic native T1 in predicting sustained ventricular arrhythmia (VA) in patients with ARVC.

Methods: This retrospective study included patients with definite ARVC who underwent cardiac magnetic resonance (CMR) examinations between November 2014 and October 2024. Hepatic native T1 values were derived from standard cardiac T1 maps. The clinical outcome was the first occurrence of sustained VA. Cox regression analysis was used to determine the association of variables with sustained VA. Incremental prognostic value was evaluated according to the concordance statistic (C-statistic), likelihood ratio test, and the continuous net reclassification index.

Results: A total of 94 patients with definite ARVC (mean age 37.3±14.2 years; 67% male) were included. At a median follow-up of 39 months, sustained VA occurred in 34 (36%) patients. In multivariable Cox analysis, hepatic native T1 was an independent predictor of sustained VA [hazard ratio (HR) =1.02, 95% confidence interval (CI): 1.00–1.03; P=0.025]. A model combining hepatic native T1 with the ARVC risk score and CMR-derived right ventricular global longitudinal strain (RV GLS) showed improved discrimination and calibration for sustained VA (C-statistic =0.760; likelihood ratio =20.14) compared with models composed of ARVC risk score alone (C-statistic =0.680; likelihood ratio =9.20; P<0.001) or the ARVC risk score and RV GLS (C-statistic =0.735; likelihood ratio =15.30; P=0.028).

Conclusions: Hepatic native T1 derived from cardiac T1 maps was an independent predictor of sustained VA in patients with ARVC, providing incremental prognostic value when incorporated into a model with ARVC risk score and RV GLS.