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Advanced Echocardiographic Imaging for Prediction of SCD in Moderate and Severe LV Systolic Function

Rebecca Perry1, Sanjana Patil2, Christian Marx2

  • 1College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Australia; Department of Heart Health, South Australian Health and Medical Research Institute, Adelaide, Australia.

JACC. Cardiovascular Imaging
|October 15, 2019
PubMed

Insights

Mechanical dispersion (MD) from echocardiography is a superior predictor of sudden cardiac death (SCD) and ventricular arrhythmias (VA) compared to left ventricular ejection fraction (LVEF) alone. This imaging technique improves risk stratification in patients with heart failure.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiac Electrophysiology

Background:

  • Left ventricular ejection fraction (LVEF) has limitations in predicting sudden cardiac death (SCD).
  • Echocardiographic strain parameters, including mechanical dispersion (MD) and global longitudinal strain (GLS), show potential for predicting ventricular arrhythmias (VA) and SCD.
  • The precise role of these strain parameters in risk stratification requires further elucidation due to historically low event rates.

Purpose of the Study:

  • To assess the long-term prognostic value of myocardial deformation imaging using echocardiography.
  • To evaluate the role of MD and GLS in risk stratification for SCD and malignant VA.
  • To analyze these parameters in a large cohort of patients with left ventricular (LV) systolic impairment of various etiologies.

Main Methods:

  • Inclusion of 939 consecutive, clinically stable outpatients with LVEF ≤45% from 2008-2014.
  • Echocardiographic strain analysis with LV segmentation into 16 regions.
  • Calculation of MD as the standard deviation of time to peak strain in the 16 regions.

Main Results:

  • A total of 96 VA events occurred during a median follow-up of 91.4 months.
  • Multivariate analysis identified MD ≥75 ms as the sole significant predictor of VA events (HR: 9.45, p < 0.0001).
  • Low MD was associated with a low event rate, independent of LVEF.

Conclusions:

  • Left ventricular ejection fraction (LVEF) alone is insufficient for predicting VA and SCD, especially in patients with moderately reduced LVEF.
  • Mechanical dispersion (MD) is a valuable, easily obtainable echocardiographic parameter for enhancing prognostic accuracy.
  • MD can improve risk stratification, particularly for patients ineligible for cardiac defibrillator insertion based solely on LVEF criteria.
Abstract

Keywords:
echocardiographymechanical dispersionsudden cardiac death

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