Global Longitudinal Strain as a Predictor of First and Subsequent Arrhythmic Events in Remotely Monitored ICD Patients With Structural Heart Disease

Guerra, Federico; Malagoli, Alessandro; Contadini, Daniele; Baiocco, Erika; Menditto, A; Bonelli, P.; Rossi, Luca; Sticozzi, C; Zanni, Alessia; Cai, Jianwen; Maitra, Poulami; Villani, Giovanni; Capucci, Alessandro

doi:10.1016/j.jcmg.2018.12.020

Cited by 24 publications

(16 citation statements)

References 25 publications

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“…Guerra et al demonstrated that reduced LV‐GLS derived by echocardiography is associated with an increased risk for appropriate ICD therapy. 6 This concurs with our results. Considering that Guerra et al examined a mixed population with different cardiomyopathies and did not differentiate patient groups with different levels of EF impairment, we hypothesize that for patients with an EF ≤ 35% the underlying structural damage and the resulting impairment in cardiac strain is too pronounced to sufficiently add any value in risk stratification.…”

Section: Discussionsupporting

confidence: 93%

“…Feature tracking (FT) is a novel cardiovascular magnetic resonance (CMR) postprocessing tool, which uses optical flow algorithms to follow myocardial image characteristics (‘features’) on cine SSFP sequences throughout the phases of the cardiac cycle in order to acquire strain parameters. This yields the potential of a contrast agent independent analysis of 3D cardiac mechanics, thereby demonstrating its potential in risk stratification for dilated cardiomyopathy (DCM) and ICM patients 3–6 …”

Section: Introductionmentioning

confidence: 98%

“…This yields the potential of a contrast agent independent analysis of 3D cardiac mechanics, thereby demonstrating its potential in risk stratification for dilated cardiomyopathy (DCM) and ICM patients. 3 , 4 , 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

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Prediction of cardiac events with non‐contrast magnetic resonance feature tracking in patients with ischaemic cardiomyopathy

et al. 2021

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Aims The aim of this study was to evaluate the prognostic value of feature tracking (FT) derived cardiac magnetic resonance (CMR) strain parameters of the left ventricle (LV)/right ventricle (RV) in ischaemic cardiomyopathy (ICM) patients treated with an implantable cardioverter‐defibrillator (ICD). Current guidelines suggest a LV‐ejection fraction ≤35% as major criterion for ICD implantation in ICM, but this is a poor predictor for arrhythmic events. Supplementary parameters are missing. Methods and results Ischaemic cardiomyopathy patients (n = 242), who underwent CMR imaging prior to primary and secondary implantation of ICD, were classified depending on EF ≤ 35% (n = 188) or >35% (n = 54). FT parameters were derived from steady‐state free precession cine views using dedicated software. The primary endpoint was a composite of cardiovascular mortality (CVM) and/or appropriate ICD therapy. There were no significant differences in FT‐function or LV‐/RV‐function parameters in patients with an EF ≤ 35% correlating to the primary endpoint. In patients with EF > 35%, standard CMR functional parameters, such as LV‐EF, did not reveal significant differences. However, significant differences in most FT parameters correlating to the primary endpoint were observed in this subgroup. LV‐GLS (left ventricular‐global longitudinal strain) and RV‐GRS (right ventricular‐global radial strain) revealed the best diagnostic performance in ROC curve analysis. The combination of LV‐GLS and RV‐GRS showed a sensitivity of 85% and a specificity of 76% for the prediction of future events. Conclusions The impact of FT derived measurements in the risk stratification of patients with ICM depends on LV function. The combination of LV‐GLS/RV‐GRS seems to be a predictor of cardiovascular mortality and/or appropriate ICD therapy in patients with EF > 35%.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 98%

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Prediction of cardiac events with non‐contrast magnetic resonance feature tracking in patients with ischaemic cardiomyopathy

et al. 2021

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“…showed that impaired GLS is associated with an increased risk of ventricular arrhythmias and appropriate ICD therapies in a consecutive 'real-world', unselected population of remotely monitored patients with structural heart disease. 20 In a large study by Hwang and collegues on 4312 patients, GLS was the best information used to develop a mortality risk prediction model for patients with acute HF syndrome. 21 Similarly, in Park and colleagues' study, GLS (not LVEF) was an independent predictor of death among the cases suffering from HF with reduced EF, HF with mid-range EF, and HF with preserved EF.…”

Section: Discussionmentioning

confidence: 99%

Global longitudinal strain for prediction of ventricular arrhythmia in patients with heart failure

et al. 2020

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Aims Currently, the ejection fraction [left ventricular ejection fraction (LVEF)] is the main criterion used for implanting implantable cardioverter defibrillators (ICDs) for primary prevention. However, many of ICD receivers would not have an event and do not have any gains from the device. Consequently, improving the discrimination strategies is needed. Here, we aimed at assessing the role of global longitudinal strain (GLS) for such purpose. Methods and results Seventy ischaemic or dilated cardiomyopathy cases characterized by LVEF ≤ 40% with a previously implanted ICD were enrolled. LVEF and GLS amounts were evaluated using 3D echocardiography. The occurrence of ventricular arrhythmias was checked by analysing the ICD history. Mean follow-up period of patients was 1.8 ± 0.6 years. There was a significant difference in the amount of GLS in arrhythmic cases compared with non-arrhythmic ones (À6.97 ± 3.06 vs À11.82 ± 4.25; P < 0.001). This difference was found in both ischaemic and dilated cardiomyopathy groups. A GLS below À10 cm/s could predict the occurrence of a ventricular event by 90% specificity and 72.2% sensitivity (area under the curve = 0.84, P < 0.001). While 27.39 (69.2%) patients with GLS below À10 cm/s had a ventricular event, only 3.31 (9.6%) of the patients with GLS above À10 had an event) P < 0.001). Those patients with a GLS ≥ 17 cm/s never experienced a ventricular arrhythmia. Conclusions Global longitudinal strain is a more accurate predictor of ventricular arrhythmias in patients with reduced LVEF. Whether it may help in selecting more appropriate patients for ICD implantation or not should be evaluated within a randomized trial in the future.

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“…Strain and strain rate are parameters describing myocardial deformation and have been shown to have prognostic value in several cardiac conditions. A recent publication demonstrated that impaired global longitudinal strain by speckle tracking was independently associated with first ICD therapy for patients with structural heart disease with such device, with a HR of 1.94 (95% CI 1.30 to 2.91, p<0.001) 21. However, measurement of strain and strain rate require high image quality and frame rate, and cannot be used when the contrast preset has been used.…”

Section: Discussionmentioning

confidence: 99%

Does stress echocardiography add incremental value to baseline ejection fraction for the early identification of candidates for implantable defibrillators?

et al. 2019

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ObjectiveA reduction in left ventricular ejection fraction (EF) remains the strongest indicator of increased risk of sudden cardiac death after an acute myocardial infarction (AMI). Guidelines recommend that patients with an EF ≤35%, 6–12 weeks after AMI should be considered for implantable cardioverter defibrillator (ICD) therapy. Stress echocardiography is a safe method to detect viability in a stunned myocardium. The purpose of this study was to investigate if stress echocardiography early after AMI could identify ICD candidates before discharge.MethodsNinety-six patients with EF ≤40% early after AMI were prospectively included in a cohort study, and investigated by baseline and stress echocardiography before discharge. Follow-up echocardiography was performed after 3 months. EF, mitral annular plane systolic excursion (MAPSE) and peak systolic velocity (PSV) were determined for each examination.ResultsThere were 80 (83%) patients who completed the baseline, stress and follow-up echocardiography. Among them there were 32 (40%) patients who met the ICD criteria of EF ≤35% at 3 months. For these patients, EF, MAPSE and PSV were significantly lower than for those patients who recovered. The area under the receiver operating characteristic curve (AUC) was 85% (95% CI 0.74 to 0.94) for baseline EF to predict non-recovery. None of the other variables had a higher AUC.ConclusionPatients who met the ICD criteria of EF ≤35% at 3 months after myocardial infarction had lower EF, MAPSE and PSV on baseline and stress echocardiograph before discharge. Stress echocardiography did not add additional value in predicting non-recovery.

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Global Longitudinal Strain as a Predictor of First and Subsequent Arrhythmic Events in Remotely Monitored ICD Patients With Structural Heart Disease

Cited by 24 publications

References 25 publications

Prediction of cardiac events with non‐contrast magnetic resonance feature tracking in patients with ischaemic cardiomyopathy

Prediction of cardiac events with non‐contrast magnetic resonance feature tracking in patients with ischaemic cardiomyopathy

Global longitudinal strain for prediction of ventricular arrhythmia in patients with heart failure

Does stress echocardiography add incremental value to baseline ejection fraction for the early identification of candidates for implantable defibrillators?

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