Speckle-Tracking Echocardiography Parameters Associated With Ventricular Arrhythmia Recurrence-Free Survival After
Siddharth J Trivedi1, Richard G Bennett2, Karen Byth3
1Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, University of Sydney, Sydney, Australia.
Insights
Prolonged delta contraction duration (DCD) measured by echocardiography is the sole echocardiographic predictor of ventricular arrhythmia recurrence-free survival after catheter ablation. This finding may aid in pre-ablation risk stratification for patients with ventricular arrhythmias.
Area of Science:
- Cardiology
- Echocardiography
- Electrophysiology
Background:
- Catheter ablation (CA) treats drug-refractory ventricular arrhythmias (VAs).
- Predicting outcomes after CA is crucial, but current methods are limited.
- Echocardiography offers novel metrics like global longitudinal strain (GLS) and mechanical dispersion (MD), and delta contraction duration (DCD) to assess myocardial function and heterogeneity.
Purpose of the Study:
- To investigate the association between clinical, procedural, and echocardiographic parameters and the risk of VA recurrence or death post-CA.
- To determine the predictive value of GLS, MD, and DCD for adverse outcomes after catheter ablation for VAs.
Main Methods:
- One hundred eighty-one patients with VAs undergoing CA were included.
- Echocardiography measured left ventricular GLS, MD, and DCD.
- Patients were followed for VA recurrence or mortality.
Main Results:
- After a median follow-up of 21.0 months, 11% died and 43% experienced VA recurrence.
- Cox regression identified acute procedural failure, inducible VAs, DCD, and GLS-DCD interaction as predictors of VA recurrence-free survival.
- Prolonged DCD (>190 ms) predicted the composite endpoint independently of GLS, while MD was less predictive than DCD.
Conclusions:
- Prolonged delta contraction duration (DCD) is the primary echocardiographic predictor of VA recurrence-free survival after catheter ablation for VAs.
- DCD may serve as a valuable tool for risk stratification before CA procedures.
- Echocardiographic assessment of myocardial contraction heterogeneity, specifically DCD, offers important prognostic information.
Background:
Catheter ablation (CA) is indicated for drug-refractory ventricular arrhythmias (VAs). Predicting adverse outcomes (recurrent VA or mortality) after CA is important, but current tools are imperfect. Speckle-tracking echocardiography quantifies global longitudinal strain (GLS), a measure of myocardial deformation, and mechanical dispersion (MD) and delta contraction duration (DCD) (measures of myocardial contraction heterogeneity). The aim of this study was to examine the associations between clinical, procedural, and echocardiographic parameters and subsequent VA recurrence or death.
Methods:
One hundred eighty-one patients (ischemic cardiomyopathy, n = 82; nonischemic cardiomyopathy, n = 99) with VAs undergoing CA underwent echocardiography, including measurements of left ventricular GLS, MD, and DCD. Patients were longitudinally followed for first occurrence of VA recurrence or death; in the absence of VA recurrence or death, a patient was deemed to have VA recurrence-free survival.
Results:
Median follow-up duration was 21.0 months. After the procedure, 20 patients (11%) died without any prior VA recurrence, and 77 patients (43%) experienced VA recurrence, of whom 11 subsequently died. Cox proportional-hazards regression analysis identified acute procedural failure, at least two inducible VAs, DCD, and the interaction between GLS and DCD as significant predictors of VA recurrence-free survival. When GLS and DCD were dichotomized by their median values (GLS ≤ -11.5% vs >-11.5%; DCD ≤ 190 vs >190 ms), DCD > 190 ms was a predictor of the composite endpoint irrespective of GLS status. MD was not as strong a predictor as DCD.
Conclusions:
In patients undergoing CA for VAs, the only echocardiographic predictor of VA recurrence-free survival was prolonged DCD, irrespective of GLS and clinical and procedural factors. Hence, DCD may facilitate risk stratification before CA.
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