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

Abstract

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.

Multimodality imaging in decompensated heart failure

“…Global longitudinal strain (GLS) indeed is superior to standard echocardiographic parameters in the prediction of all-cause mortality in HFrEF patients and has been shown to be an accurate predictor of ventricular arrhythmias. 4 In patients with acute HF, GLS has greater prognostic value than LVEF during a 5-year follow-up period.…”

CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter–Defibrillator in Non-Ischemic Cardiomyopathy

“…Global longitudinal strain (GLS) provided by speckle-tracking echocardiography (STE) is an evolving method for the evaluation of LVEF [79,80]. Nikoo et al demonstrated that GLS was superior in predicting VAs as compared to LVEF in a study population of 70 patients with ICM and DCM: by using a cut-off value of −10%, GLS had a specificity of 90% and sensitivity of 72.2% [80]. This is in line with an earlier study of 308 patients with chronic HF due to ICM and NICM that showed a sensitivity of 73% and specificity of 61% in predicting VA events.…”

Echocardiographic Advances in Dilated Cardiomyopathy

“…Tissue displacement is used to calculate myocardial deformation, a parameter shown to provide unique information on regional and global ventricular function, highly reducing inter and intra-observer variability [ 18 ]. Additionally, GLS is a more powerful predictor of prognosis and outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and DCM [ 19 , 20 ] (both ischemic and non-ischemic) and represents a novel parameter for a better selection of patients for implantable cardiac defibrillator (ICD) implantation as a more accurate predictor of ventricular arrhythmias [ 21 ]. LV GLS correlates well with invasive hemodynamic parameters [ 22 , 23 ] and independently predict LV reversed remodeling (discussed further below) in patients with DCM: patients with higher baseline GLS presented better LV functional recovery leading to less adverse clinical events [ 24 ].…”