Author + information
- Received December 10, 2018
- Revision received February 12, 2019
- Accepted March 13, 2019
- Published online February 3, 2020.
- Hiroshi Kawakami, MD, PhDa,
- Nitesh Nerlekar, MBBS, MPHa,
- Kristina H. Haugaa, MD, PhDb,
- Thor Edvardsen, MD, PhDb and
- Thomas H. Marwick, MBBS, PhD, MPHa,∗ ()
- aBaker Heart and Diabetes Institute, Melbourne, Australia
- bCentre of Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
- ↵∗Address for correspondence:
Dr. Thomas H. Marwick, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne 3004, Australia.
Objectives The aim of this study was to assess the association between left ventricular mechanical dispersion (LVMD) and the incidence of ventricular arrhythmias (VAs).
Background Recent, mainly single-center, studies have demonstrated that LVMD assessed using speckle tracking might be a powerful marker in risk stratification for VA. A systematic review and meta-analysis provides a means of understanding the prognostic value of this parameter, relative to other parameters, the most appropriate cutoff for designating risk.
Methods A systemic review of studies reporting the predictive value of LVMD for VA was undertaken from a search of MEDLINE and Embase. VA events were defined as sudden cardiac death, cardiac arrest, documented ventricular tachyarrhythmia, and appropriate implantable cardioverter-defibrillator (ICD) therapy. Hazard ratios were extracted from univariate and multivariate models reporting on the association of LVMD and VA and described as pooled estimates with 95% confidence intervals. In a meta-analysis, the predictive value of LVMD was compared with that of left ventricular ejection fraction and global longitudinal strain.
Results Among 3,198 patients in 12 published studies, 387 (12%) had VA events over follow-up ranging from 17 to 70 months. Patients with VAs had greater LVMD than those without (weighted mean difference −20.3 ms; 95% confidence interval: −27.3 to −13.2; p < 0.01). Each 10 ms increment of LVMD was significantly and independently associated with VA events (hazard ratio: 1.19; 95% confidence interval: 1.09 to 1.29; p < 0.01). The predictive value of LVMD was superior to that of left ventricular ejection fraction or global longitudinal strain.
Conclusions LVMD assessed using speckle tracking provides important predictive value for VA in patients with a number of cardiac diseases and appears to have superior predictive value over left ventricular ejection fraction and global longitudinal strain for risk stratification.
Dr. Marwick has received research support from the National Health and Medical Research Council (grants 1119955, 1080582, 1059738, and 1149692) and GE Medical Systems for an ongoing research study on the use of strain for the assessment of cardiotoxicity. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Allan L. Klein, MD, served as the Guest Editor for this paper.
- Received December 10, 2018.
- Revision received February 12, 2019.
- Accepted March 13, 2019.
- 2020 American College of Cardiology Foundation
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