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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation

Published on: October 20, 2016

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The relationship between time from myocardial infarction, left ventricular dyssynchrony, and the risk for ventricular

Darryl P Leong1, Georgette E Hoogslag2, Sebastiaan R D Piers2

  • 1Disciplines of Medicine, Flinders University and the University of Adelaide, Adelaide, Australia; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|February 1, 2015
PubMed

Insights

Left ventricular (LV) dyssynchrony, a measure of electromechanical heterogeneity, independently predicts ventricular tachycardia (VT) risk after myocardial infarction (MI). This finding is crucial for optimizing implantable cardioverter-defibrillator (ICD) therapy in primary prevention.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Imaging

Background:

  • Variable efficacy of implantable cardioverter-defibrillators (ICDs) for primary sudden cardiac death prevention after myocardial infarction (MI) may stem from differences in arrhythmogenic substrate.
  • Speckle-tracking echocardiography enables assessment of left ventricular (LV) dyssynchrony, reflecting myocardial electromechanical heterogeneity.
  • Understanding the relationship between LV dyssynchrony, MI age, and ventricular tachycardia (VT) risk is critical for refining patient management.

Purpose of the Study:

  • To evaluate the association between left ventricular (LV) dyssynchrony and the risk of ventricular tachycardia (VT) following myocardial infarction (MI).
  • To investigate the influence of myocardial infarction (MI) age on left ventricular (LV) dyssynchrony and ventricular tachycardia (VT) inducibility.
  • To determine if LV dyssynchrony is an independent predictor of VT in patients with prior MI undergoing ICD implantation.

Main Methods:

  • Retrospective analysis of 206 patients with prior MIs who underwent programmed electrical stimulation, speckle-tracking echocardiography, and ICD implantation.
  • LV dyssynchrony quantified by the standard deviation of time to peak longitudinal systolic strain.
  • Follow-up for median 24 months to record the first occurrence of monomorphic VT requiring ICD therapy.

Main Results:

  • Left ventricular (LV) dyssynchrony was independently associated with an increased risk of VT (HR per 10-msec increase: 1.12; P < .001).
  • Nonrevascularization of the infarct-related artery and VT inducibility were also independent predictors of VT.
  • Patients with older MIs (>180 months) exhibited higher VT inducibility (88% vs 63%; P = .003) and greater scar burden (14.7% vs 10.7%; P = .03) compared to those with recent MIs (<8 months).

Conclusions:

  • Left ventricular (LV) dyssynchrony is a significant independent predictor of ventricular tachycardia (VT) occurrence after myocardial infarction (MI).
  • These findings highlight the importance of assessing LV dyssynchrony for risk stratification and optimizing ICD therapy in post-MI patients.
  • The age of MI influences VT inducibility and scar burden, suggesting evolving arrhythmogenic substrate over time.
Abstract

Keywords:
EchocardiographyMyocardial infarctionScarStrainVentricular tachycardia

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