Related Experiment Video
Updated: Jan 29, 2026
Examining the Characteristics of Episodic Memory using Event-related Potentials in Patients with Alzheimer's Disease
Published on: August 30, 2011
Global Longitudinal Strain as a Predictor of First and Subsequent Arrhythmic Events in Remotely Monitored ICD
Federico Guerra1, Alessandro Malagoli2, Daniele Contadini1
1Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital Umberto I, Lancisi-Salesi, Ancona, Italy.
Insights
Global longitudinal strain (GLS) predicts initial ventricular arrhythmias (VAs) and ICD therapies in structural heart disease patients. However, GLS, mechanical dispersion (MD), and delta contraction duration (DCD) do not predict subsequent events.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Left ventricular ejection fraction (LVEF) has limitations for risk stratification in structural heart disease patients with ventricular arrhythmias (VAs).
- Novel echocardiographic parameters may offer improved prediction of ventricular events.
Purpose of the Study:
- To evaluate speckle-tracking echocardiography-derived parameters, including global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD), as predictors of first and subsequent ventricular events in patients with structural heart disease and implantable cardioverter-defibrillators (ICDs).
Main Methods:
- Retrospective, observational study of 203 patients with structural heart disease undergoing ICD implantation and remote monitoring.
- Two-dimensional (2D) speckle-tracking analysis derived GLS, MD, and DCD at enrollment.
- Recurrent event statistical analysis assessed subsequent ventricular events after the first event.
Main Results:
- Lower GLS quartiles were associated with an increased risk of antitachycardia pacing or shock (p=0.003) and VAs (p=0.001).
- Impaired GLS independently predicted the first ICD therapy (HR: 1.94) and the first VA (HR: 1.42).
- LVEF, MD, and DCD did not predict first or subsequent ventricular events. GLS did not predict recurrent events.
Conclusions:
- Impaired GLS is a significant predictor of initial ventricular arrhythmias and appropriate ICD therapies in a real-world population of remotely monitored patients with structural heart disease.
- GLS, MD, and DCD are not reliable predictors of recurrent arrhythmic events in this patient cohort.
Objectives:
This study sought to assess speckle-tracking-derived parameters as predictors of first and subsequent ventricular events in patients with structural heart disease and implantable cardioverter-defibrillators (ICD).
Background:
Left ventricular ejection fraction (LVEF), the current primary parameter of risk stratification for ventricular arrhythmias (VAs) in structural heart diseases is burdened by many limitations.
Methods:
In this retrospective, observational study, all consecutive patients with structural heart disease were admitted for ICD implantation. Patients not followed by a home-monitoring system were excluded. Two-dimensional (2D) speckle-tracking analysis was used to derive global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD) of all patients at enrollment. Home monitoring was checked weekly to detect all VAs and ICD therapies. A recurrent event statistical approach (Prentice, Williams, and Peterson model) was applied to evaluate subsequent events after the first ones.
Results:
A total of 203 patients were consecutively enrolled and followed for a median of 2.2 years. Kaplan-Meier curves showed an increased risk of antitachycardia pacing or shock (log-rank p = 0.003) and VAs (log-rank p = 0.001) associated with lower quartiles of GLS. An impaired GLS was independently associated with an increased risk for the first ICD therapy (hazard ratio [HR]: 1.94; 95% confidence interval [CI]: 1.30 to 2.91; p = 0.001) and (HR: 1.42; 95% CI: 1.01 to 1.98; p = 0.04) for the first VA. GLS impairment was not significantly associated with an increased risk of recurrent ICD therapies or VAs. LVEF, MD, and DCD were not associated with an increased risk of first, second, and third ICD therapies or VA.
Conclusions:
Impaired GLS is associated with an increased risk of VAs and appropriate ICD therapies in a consecutive "real-world," unselected population of remotely monitored patients with structural heart disease, although it does not seem reliable in predicting further arrhythmic events after the first one. MD and DCD do not predict first or subsequent arrhythmic events in ICD patients with structural heart disease.
Related Concept Videos
01:50Global Climate Change
02:20Longitudinal Research
01:23Rheumatic Heart Disease I: Introduction
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:21Rheumatic Heart Disease III: Medical Management
01:20Rheumatic Heart Disease IV: Nursing Management