Global Longitudinal Strain and Left Ventricular Mechanical Dispersion in Patients With Preserved Ejection Fraction...

Specific tools are lacking for sudden cardiac arrest (SCA) risk assessment in patients with preserved left ventricular ejection fraction (LVEF) and nonhypertrophic ventricles. We hypothesized that echocardiographic global longitudinal strain (GLS) and left ventricular mechanical dispersion (LVMD) identify patients at risk of SCA in subjects with preserved LVEF. In this case-control study, patients evaluated in the electrophysiology clinic due to SCA between 2017 and 2022 were identified and matched 1:2 by age and sex with controls without SCA. Subjects were included if they had preserved LVEF (≥50%). GLS and LVMD (standard deviation of time to peak regional longitudinal strain from 16 segments) were computed offline using speckle-tracking echocardiography. For patients without coronary artery disease (CAD) or ischemic stroke, we calculated atherosclerotic cardiovascular disease and PREVENT risk scores. In 129 subjects (43 SCA, 86 controls) CAD was more frequent in the SCA group (48% vs 29%, p = 0.039). GLS, and LVMD significantly differed between the groups. Impaired GLS (≥-14%), prolonged LVMD (≥75 ms) and CAD were associated with SCA. Yet, GLS and LVMD were independent and incremental to the association between CAD and SCA. Adding GLS increased the strength of the association between CAD and SCA (Chi-square = 13.2, p = 0.001), and adding both GLS and LVMD further strengthened this association (Chi-square = 16.3, p <0.001). In patients without overt cardiovascular disease, GLS and LVMD remained significantly associated with SCA independently of atherosclerotic cardiovascular disease and PREVENT risk scores. In patients with preserved LVEF, GLS and LVMD appear to be promising SCA risk markers beyond CAD.