Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Abstract

Background— Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics. Methods and Results— We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P <0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, −7.7% versus −8.8%; P <0.001; lateral-strain, −7.3% versus −7.9%; P =0.022; inferior-strain, −8.3% versus −9.9%; P <0.001; septal-strain, −9.1% versus −10.0%; P <0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03–1.13]; P =0.001; inferior: hazard ratio, 1.08 [1.04–1.12]; P <0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00–1.11]; P =0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P =0.005). Conclusions— Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00180271.

Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population

“…Furthermore, GLS has prognostic value in patients in a range of cardiovascular disorders, including AMI 25 , and HF with reduced (HFrEF) 11,26 and preserved LVEF (HFpEF) 27 , and also recently in the general population 9,10,28 . However, previous studies assessing the prognostic significance of GLS in the general population have been limited by relatively short follow-up time (approximately 5 years), 9,10,28 particularly as current risk models assess CV risk over a 10 years period.…”

Prognostic importance of left ventricular mechanical dyssynchrony in heart failure with preserved ejection fraction

“…Previous studies have described SD T2P LS as a strong predictor of ventricular arrhythmias, although recent reports suggest limited utility of this measure to predict arrhythmic events in HFrEF . No study has previously assessed whether this measure is associated with ventricular arrhythmias in HFpEF.…”

Echocardiography in patients with heart failure: recent advances and future perspectives

“…GLS was helpful in predicting reverse remodeling and 1-year mortality after CRT implantation [65], and longitudinal deformation-based measures of LV dyssynchrony proved to be strong prognosticators of ventricular arrhythmias in HFrEF [66,67]. The incremental value in predicting ventricular tachycardia/fibrillation was demonstrated for reduced longitudinal strain in the inferior wall [68], which underpins the importance of LV regional function assessment in the diagnostic work-up in…”