Global longitudinal strain and left atrial volume index improve prediction of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy patients

Abstract

Accurate predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in hypertrophic cardiomyopathy (HCM) patients are lacking. Both left atrial volume index (LAVI) and global longitudinal strain (GLS) have been proposed as prognostic markers in HCM patients. The specific value of LAVI and GLS to predict appropriate ICD therapy in high-risk HCM patients was studied. LAVI and 2-dimensional speckle tracking-derived GLS were assessed in 92 HCM patients undergoing ICD implantation (69 % men, mean age 50 ± 14 years). During long-term follow-up, appropriate ICD therapies, defined as antitachycardia pacing and/or shock for ventricular arrhythmia, were recorded. Appropriate ICD therapy occurred in 21 patients (23 %) during a median follow-up of 4.7 (2.2-8.2) years. Multivariate analysis revealed LAVI (p = 0.03) and GLS (p = 0.04) to be independent predictors of appropriate ICD therapy. Both LAVI and GLS showed higher accuracy to predict appropriate ICD therapy compared to presence of ≥1 conventional sudden cardiac death (SCD) risk factor(s) [area under the curve 0.76 (95 % CI 0.65-0.87) and 0.65 (95 % CI 0.54-0.77) versus 0.52 (95 % CI 0.43-0.58) respectively, p < 0.001]. No patient with both LAVI <34 mL/m(2) and GLS <-14 % experienced appropriate ICD therapy. Assessment of both LAVI and GLS on top of conventional SCD risk factors provided incremental clinical predictive value for appropriate ICD therapy, as shown by likelihood ratio test (p < 0.001) and integrated discrimination improvement index (0.17, p < 0.001). LAVI and GLS provide high negative predictive value for appropriate ICD therapy in high-risk HCM patients. Additionally to conventional SCD risk factors, both parameters may be useful to optimize criteria and timing for ICD implantation in these patients.

Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy

“…However, it is all the time debated how to define the best cut-off value to use in practice. A cut-off of 14%,13 15%15 or 16%28 should be more sensitive than 10% but less specific. However, according to our Kaplan–Meier survival analyses, we think that patients with HCM with GLS below 15.6% have higher risk or cardiac events than patients with GLS ≥15.6%.…”

“…Our feeling is that more GLS is altered (<16%), more we should considered the patient at risk of poor outcomes, particularly HF but equally ventricular arrhythmia. Another study by Debonnaire et al 13 underscored the potential interest of GLS (using a cut-off value of 14%) as a predictive marker for appropriate implantable cardioverter defibrillator therapy in 21 out of 92 high-risk patients with HCM. In another study, reduced longitudinal septal strain and increased extent of interstitial fibrosis were predictors of ventricular arrhythmias 14.…”

Cardiovascular imaging 2014 in the International Journal of Cardiovascular Imaging

“…Both left atrial volume index and global longitudinal strain have been proposed as prognostic markers in hypertrophic cardiomyopathy patients. The specific value of left atrial volume index and global longitudinal strain to predict appropriate ICD therapy in highrisk hypertrophic cardiomyopathy patients was studied by Debonnaire et al [13]. Left atrial volume index and 2-dimensional speckle tracking-derived global longitudinal strain were assessed in 92 hypertrophic cardiomyopathy patients undergoing ICD implantation (69 % men, mean age 50 ± 14 years).…”

Left Atrial Size: An Underappreciated Perioperative Cardiac Risk Factor

“…64 Additionally, in patients with hypertrophic cardiomyopathy, LA volume index has shown high negative predictive values for appropriate implantable cardioverter-defibrillator therapy. 65 …”