The Relationship between Time from Myocardial Infarction, Left Ventricular Dyssynchrony, and the Risk for Ventricular Arrhythmia: Speckle-Tracking Echocardiographic Analysis

Leong, Darryl P.; Hoogslag, Georgette E.; Piers, Sebastiaan R.D.; Höke, Ulas; Thijssen, Joep; Marsan, Nina Ajmone; Schalij, Martin J.; Zeppenfeld, Katja; Bax, Jeroen J.; Delgado, Victoria

doi:10.1016/j.echo.2014.12.012

Cited by 36 publications

(15 citation statements)

References 33 publications

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“…8 In addition, a heterogeneous myocardial contraction pattern determined by a dyssynchronic ventricular contraction (known as MD or dyssynchrony) has also been demonstrated useful to predict ventricular arrhythmias. 6,7 In contrast to previous studies, [24][25][26] we did not find MD to be a strong predictor of ventricular tachyarrhythmias (Table 2). This might be because of the fact that we only obtained MD from 12 segments (apical 4-and 2-chamber views) instead of 18 segments or because 2DSE was performed on Digital Imaging and Communications in Medicine images leading to lower frame rates than used in previous studies.…”

Section: Myocardial Deformation and Prognosiscontrasting

confidence: 56%

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Knappe

Pouleur

Claggett

et al. 2017

Circ: Cardiovascular Imaging

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Background— Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics. Methods and Results— We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P <0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, −7.7% versus −8.8%; P <0.001; lateral-strain, −7.3% versus −7.9%; P =0.022; inferior-strain, −8.3% versus −9.9%; P <0.001; septal-strain, −9.1% versus −10.0%; P <0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03–1.13]; P =0.001; inferior: hazard ratio, 1.08 [1.04–1.12]; P <0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00–1.11]; P =0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P =0.005). Conclusions— Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00180271.

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Section: Myocardial Deformation and Prognosiscontrasting

confidence: 56%

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Knappe

Pouleur

Claggett

et al. 2017

Circ: Cardiovascular Imaging

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“…13 Studies have shown that strain-derived mechanical dys-synchrony abnormalities are independently associated with LVEF changes over time in regard to idiopathic dilated cardiomyopathy, as well as the occurrence of ventricular tachycardia after myocardial infarction (MI). 14,15 In the present study, we evaluated for the first time early cardiac function changes after anthracycline therapy with layer-specific STE and mechanical dys-synchrony.…”

Section: Introductionmentioning

confidence: 99%

The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

Liu

et al. 2019

Echocardiography

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Purpose The primary aim of this study was to evaluate early changes in cardiac function after anthracycline therapy with layer‐specific speckle‐tracking echocardiography (STE) and mechanical dys‐synchrony. Methods A total of 78 breast cancer patients (ranging 31~72 years) exposed to anthracycline treatment were recruited in this study. All patients received both conventional two‐dimensional speckle‐tracking echocardiographs at baseline, as well as after the completion of 2 and 4 cycles of the regimen. Layer‐specific longitudinal strain (LS) and circumferential strain (CS) of the 3 myocardial layers (endocardium, mid‐myocardium, and epicardium) were automatically measured. Peak systolic dispersion (PSD) was defined as the standard deviation of the time to peak strain of the 18 segments, divided by the RR interval. Results There were no significant differences in conventional echocardiographic parameters during treatment (all P > .05). Peak endocardium CS at basal level decreased significantly after 2 and 4 cycles compared with baseline (both P = .001), while PSD significantly increased in that same period versus baseline (both P = .000). Endocardium and mid‐myocardium LS, peak mid‐myocardium and epicardium CS at the basal level, peak CS of all three layers at the papillary level, and peak endocardium and mid‐myocardium CS at the apical level all significantly decreased after 4 cycles, compared with baseline and 2 cycles (all P = .000). Conclusion This study showed that myocardial deformation impairment occurred as early as 2 cycles after anthracycline chemotherapy. Endocardium CS at the basal level and left ventricular dys‐synchrony index PSD were the initial cardiac abnormalities in anthracycline‐treated breast cancer patients.

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“…Mounting evidence supports that LVMD has an independent and incremental negative impact on myocardial mechanics and remodeling. In the study by Leong et al, LV dyssynchrony is independently associated with changes in the LVEF over time in idiopathic dilated cardiomyopathy and occurrence of ventricular tachycardia after myocardial infarction (17). Fudim M et al demonstrated that LV dyssynchrony were strongly associated with adverse outcomes among patients with coronary heart disease (18).…”

Section: Discussionmentioning

confidence: 99%

Layer‐specific strain and dyssynchrony index alteration in new-onset systemic lupus erythematosus patients without cardiac symptom

Luo

Wang

Chen

et al. 2020

Preprint

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Background Layer-specific speckle-tracking echocardiography (STE) is a noninvasive approach assessing subclinical left ventricular (LV) dysfunction. We aimed to investigate: (I) layer‐specific strain and dyssynchrony index alteration; (II) disease parameters associated with layer-specific STE change; (III) effects of hydroxychloroquine (HCQ) therapy on layer-specific STE parameters in drug-naïve patients with new-onset systemic lupus erythematosus (SLE) without cardiac symptoms. Methods 35 drug-naïve patients with new-onset SLE and 25 age-and-sex-matched healthy controls were enrolled. All individuals received both conventional echocardiographic and two-dimensional STE assessment. Layer-specific global longitudinal strain (GLS), global circumferential strain (GCS) and peak systolic dispersion (PSD) were acquired in layer-specific STE. The effect of HCQ monotherapy on GLS parameters and PSD was assessed in 7 SLE patients with stable disease. Results All patients had normal left ventricular ejection fraction (LVEF). Conventional echocardiographic parameters were comparable between patients and controls. Decreased layer-specific GLS and elevated PSD were observed in SLE patients. In contrast, there’s no difference of layer-specific GCS at the basal level, papillary muscle level and apical level between patients and controls. More severely impaired GLS was observed in patients with higher disease activity, high-risk aPL profile or renal involvement. PSD increased in patients with higher disease activity or high-risk aPL profile. Correlational analysis showed that GLS at three layers and PSD correlated with high-sensitivity CRP (hsCRP) levels. PSD correlated with epicardial GLS, when treating hsCRP level, renal involvement, profile of aPL and disease activity as control variables. Multivariate regression showed hsCRP level and epicardial GLS are the predictors of layer-specific GLS impairment and elevated PSD, respectively. No change of GLS at three layers or PSD was observed in the first 6 months of HCQ treatment, compared with baseline. During the second 6 months of HCQ treatment, increase of endocardial GLS and whole layer GLS, and decrease of PSD were detected. There was no change of epicardial GLS during follow-up. Conclusion Drug-naïve patients with new-onset SLE, even having normal LVEF, are likely to have subclinical GLS impairment and LV dyssynchrony. SLE-related risk factors are associated with these dysfunctions. Continuous use of HCQ may provide beneficial effects to the silent cardiac impairment.

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The Relationship between Time from Myocardial Infarction, Left Ventricular Dyssynchrony, and the Risk for Ventricular Arrhythmia: Speckle-Tracking Echocardiographic Analysis

Cited by 36 publications

References 33 publications

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

Layer‐specific strain and dyssynchrony index alteration in new-onset systemic lupus erythematosus patients without cardiac symptom

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