Rebecca Perry1, Sanjana Patil2, Christian Marx2, Matthew Horsfall3, Derek P Chew1, Karthigesh Sree Raman1, Noor Darinah Mohd Daril4, Kathryn Tiver5, Majo X Joseph5, Anand N Ganesan5, Andrew McGavigan5, Gaetano Nucifora6, Joseph B Selvanayagam7. 1. College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia; Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia. 2. College of Medicine and Public Health, Flinders University, Bedford Park, Australia. 3. Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia. 4. Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia. 5. College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia. 6. College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Manchester University NHS Foundation Trust, Manchester, United Kingdom. 7. College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia; Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia. Electronic address: joseph.selvanayagam@flinders.edu.au.
Abstract
OBJECTIVES: This study sought to determine the long-term prognostic value of myocardial deformation imaging by echocardiography in risk stratification of sudden cardiac death (SCD) and malignant ventricular arrhythmias (VAs) in a large consecutive cohort of patients with left ventricular (LV) systolic impairment, irrespective of its etiology. BACKGROUND: Left ventricular ejection fraction (LVEF) is limited for prediction of SCD. Echocardiographic strain-derived mechanical dispersion (MD) and global longitudinal strain (GLS) has been linked to VA and SCD. However, due to low event rates, the role of these parameters has not been fully elucidated. METHODS: Consecutive clinically stable patients who underwent echocardiographic study performed in an outpatient setting from 2008 to 2014 with a Simpson left ventricular ejection fraction (LVEF) ≤45% were included in the study. Strain analysis was performed in which the LV was separated into 16 segments for regional analysis. Mechanical dispersion (MD) was calculated as the SD of the time to peak of each of the 16 regions. Outcome data were obtained from medical records. RESULTS: A total of 939 patients were included in the study, with median LVEF of 37% (interquartile range 30% to 42%). At follow-up (91.4 ± 23.4 months), 96 VA events had occurred. Multivariate analysis demonstrated that only MD ≥75 ms (hazard ratio: 9.45; 95% confidence interval: 4.75 to 18.81; p < 0.0001) was predictive of VA events. Low MD predicted a low event rate, irrespective of LVEF. CONCLUSIONS: Using LVEF alone is inferior for prediction of VA and SCD, particularly in patients with moderately reduced LVEF. MD is easily obtained from standard echocardiographic images and can be used to improve risk prognosis, particularly in patients who are currently excluded from cardiac defibrillator insertion based on LVEF. Crown
OBJECTIVES: This study sought to determine the long-term prognostic value of myocardial deformation imaging by echocardiography in risk stratification of sudden cardiac death (SCD) and malignant ventricular arrhythmias (VAs) in a large consecutive cohort of patients with left ventricular (LV) systolic impairment, irrespective of its etiology. BACKGROUND: Left ventricular ejection fraction (LVEF) is limited for prediction of SCD. Echocardiographic strain-derived mechanical dispersion (MD) and global longitudinal strain (GLS) has been linked to VA and SCD. However, due to low event rates, the role of these parameters has not been fully elucidated. METHODS: Consecutive clinically stable patients who underwent echocardiographic study performed in an outpatient setting from 2008 to 2014 with a Simpson left ventricular ejection fraction (LVEF) ≤45% were included in the study. Strain analysis was performed in which the LV was separated into 16 segments for regional analysis. Mechanical dispersion (MD) was calculated as the SD of the time to peak of each of the 16 regions. Outcome data were obtained from medical records. RESULTS: A total of 939 patients were included in the study, with median LVEF of 37% (interquartile range 30% to 42%). At follow-up (91.4 ± 23.4 months), 96 VA events had occurred. Multivariate analysis demonstrated that only MD ≥75 ms (hazard ratio: 9.45; 95% confidence interval: 4.75 to 18.81; p < 0.0001) was predictive of VA events. Low MD predicted a low event rate, irrespective of LVEF. CONCLUSIONS: Using LVEF alone is inferior for prediction of VA and SCD, particularly in patients with moderately reduced LVEF. MD is easily obtained from standard echocardiographic images and can be used to improve risk prognosis, particularly in patients who are currently excluded from cardiac defibrillator insertion based on LVEF. Crown
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