Introduction:
Abnormal left ventricular ejection fraction (LVEF) is the traditional parameter used to assess the risk of sudden cardiac death (SCD), but most SCD events occur in patients with LVEF >40%.
Hypothesis:
We hypothesized that global longitudinal strain (GLS) can predict SCD in patients with heart failure and implantable cardiac devices.
Methods:
This was a retrospective cohort study. Device interrogation and chart review was done for demographic, clinical and echocardiographic characteristics and assessment of outcomes; ventricular tachycardia (VT) or ventricular fibrillation (VF), all-cause mortality, cardiac hospitalizations, non-sustained VT and new atrial fibrillation (AF). Cox-regression analysis was performed for the association between GLS, other clinical and echocardiographic parameters and outcomes.
Results:
A total of 180 patients were included with males 176 (98%), HFrEF (LVEF<40%) 58 (33%), HFmEF (LVEF 40-50%) 37 (21%), HFpEF 83 (46%), ischemic cardiomyopathy 78 (43%) and non-ischemic cardiomyopathy 39 (22%). Over a median follow up of 31 months, 29 (16%) developed sustained VT/VF, 33 (18%) died, 55 (31%) had cardiac hospitalization, 74 (41%) had non-sustained VT and 25 (14%) developed new AF. Abnormal GLS (≥-17%) predicted VT/VF (HR=4.0, 95% CI 1.2 - 13.3, p=0.02) and mortality (HR=4.2, 95% CI 1.5 - 11.9, p=0.008) in the entire population. Notably, in the HFpEF group, abnormal GLS was the only predictor of mortality (HR=3.5, 95% CI 1.1 - 10.8, p=0.02; Figure 1).
Conclusions:
Abnormal GLS is a predictor of ventricular arrhythmias and mortality in patients with heart failure. In patients with HFpEF, GLS may be used for risk stratification upon further validation in larger studies.
Left Ventricular Global Longitudinal Strain Can Reliably Be Measured from a Single Apical Four-Chamber View in Patients with Heart Failure
