Author + information
- Received May 10, 2019
- Revision received July 8, 2019
- Accepted July 11, 2019
- Published online October 16, 2019.
- Rebecca Perry, BSc, PhDa,b,c,
- Sanjana Patil, BBMed, BSc (Hons)a,
- Christian Marx, BParamedicSca,
- Matthew Horsfall, RNb,
- Derek P. Chew, MBBS, PhDa,b,c,
- Karthigesh Sree Raman, BMBSa,b,c,
- Noor Darinah Mohd Daril, MD, MMed Int Medc,
- Kathryn Tiver, BMBSa,b,
- Majo X. Joseph, MBBSa,b,
- Anand Ganesan, MBBS, PhDa,b,
- Andrew McGavigan, MBChB, MDa,b,
- Gaetano Nucifora, MD, PhDa,d and
- Joseph B. Selvanayagam, MBBS (Hons), DPhila,b,c,∗ (, )@josephselvacmr
- aCollege of Medicine and Public Health, Flinders University, Bedford Park, Australia
- bDepartment of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia
- cDepartment of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia
- dManchester University NHS Foundation Trust, Manchester, United Kingdom
- ↵∗Address for correspondence:
Dr. Joseph B. Selvanayagam, College of Medicine and Public Health, Flinders University, Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia 5042, Australia.
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 standard deviation 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 implantation based on LVEF.
This work was supported by the National Heart Foundation of Australia Post-Doctoral Fellowship 100871 to Dr. Perry. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 10, 2019.
- Revision received July 8, 2019.
- Accepted July 11, 2019.
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