Longitudinal strain with speckle-tracking echocardiography predicts electroanatomic substrate for ventricular tachycardia in nonischemic cardiomyopathy patients

Longitudinal strain (LS) derived from speckle-tracking echocardiography (STE) corresponds to regions of scar in ischemic cardiomyopathy.

We investigated if regional LS abnormalities correlate with scar location and scar burden, identified using high-density electroanatomic mapping (EAM) in nonischemic cardiomyopathy (NICM).

Fifty NICM patients with ventricular tachycardia (VT) underwent echocardiography; multilayer (endocardial, midmyocardial, and epicardial) regional LS and global LS (GLS) were evaluated prior to EAM for detection of low-voltage scar. Patients were divided into 3 groups by EAM left ventricular scar location: (1) anteroseptal (group 1, n = 20); (2) inferolateral (group 2, n = 20); and (3) epicardial scar (group 3; n = 10). We correlated (1) location of scar to regional LS and (2) regional strain and GLS to scar percentage.

Regional LS abnormalities correlated with EAM scar in all groups. Segmental impaired LS and low voltage on EAM demonstrated concordance with scar in ∼75% or its border zone in 25% of segments. In groups 1 and 2, endocardial GLS showed a strong linear correlation with endocardial bipolar scar percentage (r = 0.79, 0.75 for groups 1 and 2, respectively; P < .001), whereas midmyocardial GLS correlated with unipolar scar percentage (r = 0.82, 0.78 for groups 1 and 2, respectively; P < .001). In group 3, epicardial regional LS and GLS correlated with epicardial bipolar scar percentage (r = 0.72, P < .001).

Regional abnormalities on LS predict scar location on EAM mapping in patients with NICM. Moreover, global and regional LS correlate with scar percentage. STE could be used as a noninvasive tool for localizing and quantifying scar prior to EAM.