A review of alternative measurements in strain imaging for ventricular arrhythmia prediction

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Electrophysiology

Background:

• Global longitudinal strain (GLS) assesses left ventricular function and detects subclinical dysfunction missed by ejection fraction.
• Ventricular arrhythmias are a leading cause of sudden cardiac death, necessitating early detection and risk stratification.
• Various imaging modalities and novel echocardiographic techniques are explored for predicting ventricular arrhythmias.

Purpose of the Study:

• To review the utility of echocardiographic markers, including GLS, radial strain, mechanical dispersion, and myocardial work, in predicting ventricular arrhythmias.
• To highlight the specific value of GLS in patients with preserved ejection fraction and normal conventional echocardiographic parameters.
• To assess the current understanding of mechanical dispersion as a predictor of ventricular arrhythmias across different patient populations, noting a gap in metabolic syndrome.

Main Methods:

• Literature review of studies investigating echocardiographic parameters for ventricular arrhythmia prediction.
• Analysis of existing research on global longitudinal strain, radial strain, mechanical dispersion, and myocardial work.
• Examination of studies focusing on specific patient cohorts, including heart failure, ischemic heart disease, long QT syndrome, arrhythmogenic cardiomyopathy, and congenital heart disease.

Main Results:

• Global longitudinal strain is a valuable marker for left ventricular function and detecting subclinical dysfunction, particularly when traditional echocardiographic measures are normal.
• Mechanical dispersion has been extensively studied in relation to ventricular arrhythmias in various conditions.
• The role of mechanical dispersion in predicting ventricular arrhythmias within the context of metabolic syndrome remains largely unexplored.

Conclusions:

• Global longitudinal strain and mechanical dispersion are emerging echocardiographic markers with potential for predicting ventricular arrhythmias.
• GLS offers prognostic value in patients with seemingly normal cardiac function.
• Further investigation into mechanical dispersion's role in metabolic syndrome is warranted to improve risk stratification for sudden cardiac death.