Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction

Kristina H Haugaa; Bjørnar L Grenne; Christian H Eek; Mads Ersbøll; Nana Valeur; Jesper H Svendsen; Anca Florian; Benthe Sjøli; Harald Brunvand; Lars Køber; Jens-Uwe Voigt; Walter Desmet; Otto A Smiseth; Thor Edvardsen

doi:10.1016/j.jcmg.2013.03.005

Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction

Kristina H Haugaa, Bjørnar L Grenne, Christian H Eek, Mads Ersbøll, Nana Valeur, Jesper H Svendsen, Anca Florian, Benthe Sjøli, Harald Brunvand, Lars Køber, Jens-Uwe Voigt, Walter Desmet, Otto A Smiseth, Thor Edvardsen

148 Citations (Scopus)

Abstract

Objectives The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI). Background Prediction of ventricular arrhythmias after MI is challenging. Left ventricular ejection fraction (LVEF) <35% is the main parameter for selecting patients for implantable cardioverter- defibrillator therapy. Methods In this prospective, multicenter study, 569 patients >40 days after acute MI were included, 268 of whom had ST-segment elevation MIs and 301 non-ST-segment elevation MIs. By echocardiography, global strain was assessed as average peak longitudinal systolic strain from 16 left ventricular segments. Time from the electrocardiographic R-wave to peak negative strain was assessed in each segment. Mechanical dispersion was defined as the standard deviation from these 16 time intervals, reflecting contraction heterogeneity. Results Ventricular arrhythmias, defined as sustained ventricular tachycardia or sudden death during a median 30 months (interquartile range: 18 months) of follow-up, occurred in 15 patients (3%). LVEFs were reduced (48 ± 17% vs. 55 ± 11%, p < 0.01), global strain was markedly reduced (-14.8 ± 4.7% vs. -18.2 ± 3.7%, p = 0.001), and mechanical dispersion was increased (63 ± 25 ms vs. 42 ± 17 ms, p < 0.001) in patients with arrhythmias compared with those without. Mechanical dispersion was an independent predictor of arrhythmic events (per 10-ms increase, hazard ratio: 1.7; 95% confidence interval: 1.2 to 2.5; p < 0.01). Mechanical dispersion and global strain were markers of arrhythmias in patients with non-ST-segment elevation MIs (p < 0.05 for both) and in those with LVEFs >35% (p < 0.05 for both), whereas LVEF was not (p = 0.33). A combination of mechanical dispersion and global strain showed the best positive predictive value for arrhythmic events (21%; 95% confidence interval: 6% to 46%). Conclusions Mechanical dispersion by strain echocardiography predicted arrhythmic events independently of LVEF in this prospective, multicenter study of patients after MI. A combination of mechanical dispersion and global strain may improve the selection of patients after MI for implantable cardioverter-defibrillator therapy, particularly in patients with LVEFs >35% who did not fulfill current implantable cardioverter-defibrillator indications.

Original language	English
Journal	J A C C: Cardiovascular Imaging
Volume	6
Issue number	8
Pages (from-to)	841-850
Number of pages	10
ISSN	1936-878X
DOIs	https://doi.org/10.1016/j.jcmg.2013.03.005
Publication status	Published - Aug 2013

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10.1016/j.jcmg.2013.03.005

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Haugaa, K. H., Grenne, B. L., Eek, C. H., Ersbøll, M., Valeur, N., Svendsen, J. H., Florian, A., Sjøli, B., Brunvand, H., Køber, L., Voigt, J-U., Desmet, W., Smiseth, O. A., & Edvardsen, T. (2013). Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction. J A C C: Cardiovascular Imaging, 6(8), 841-850. https://doi.org/10.1016/j.jcmg.2013.03.005

Haugaa, KH, Grenne, BL, Eek, CH, Ersbøll, M, Valeur, N, Svendsen, JH, Florian, A, Sjøli, B, Brunvand, H, Køber, L, Voigt, J-U, Desmet, W, Smiseth, OA & Edvardsen, T 2013, 'Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction', J A C C: Cardiovascular Imaging, vol. 6, no. 8, pp. 841-850. https://doi.org/10.1016/j.jcmg.2013.03.005

@article{d2391dd5416b49409bec1c0df5f4c8ac,

title = "Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction",

abstract = "Objectives The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI). Background Prediction of ventricular arrhythmias after MI is challenging. Left ventricular ejection fraction (LVEF) <35% is the main parameter for selecting patients for implantable cardioverter- defibrillator therapy. Methods In this prospective, multicenter study, 569 patients >40 days after acute MI were included, 268 of whom had ST-segment elevation MIs and 301 non-ST-segment elevation MIs. By echocardiography, global strain was assessed as average peak longitudinal systolic strain from 16 left ventricular segments. Time from the electrocardiographic R-wave to peak negative strain was assessed in each segment. Mechanical dispersion was defined as the standard deviation from these 16 time intervals, reflecting contraction heterogeneity. Results Ventricular arrhythmias, defined as sustained ventricular tachycardia or sudden death during a median 30 months (interquartile range: 18 months) of follow-up, occurred in 15 patients (3%). LVEFs were reduced (48 ± 17% vs. 55 ± 11%, p < 0.01), global strain was markedly reduced (-14.8 ± 4.7% vs. -18.2 ± 3.7%, p = 0.001), and mechanical dispersion was increased (63 ± 25 ms vs. 42 ± 17 ms, p < 0.001) in patients with arrhythmias compared with those without. Mechanical dispersion was an independent predictor of arrhythmic events (per 10-ms increase, hazard ratio: 1.7; 95% confidence interval: 1.2 to 2.5; p < 0.01). Mechanical dispersion and global strain were markers of arrhythmias in patients with non-ST-segment elevation MIs (p < 0.05 for both) and in those with LVEFs >35% (p < 0.05 for both), whereas LVEF was not (p = 0.33). A combination of mechanical dispersion and global strain showed the best positive predictive value for arrhythmic events (21%; 95% confidence interval: 6% to 46%). Conclusions Mechanical dispersion by strain echocardiography predicted arrhythmic events independently of LVEF in this prospective, multicenter study of patients after MI. A combination of mechanical dispersion and global strain may improve the selection of patients after MI for implantable cardioverter-defibrillator therapy, particularly in patients with LVEFs >35% who did not fulfill current implantable cardioverter-defibrillator indications.",

author = "Haugaa, {Kristina H} and Grenne, {Bj{\o}rnar L} and Eek, {Christian H} and Mads Ersb{\o}ll and Nana Valeur and Svendsen, {Jesper H} and Anca Florian and Benthe Sj{\o}li and Harald Brunvand and Lars K{\o}ber and Jens-Uwe Voigt and Walter Desmet and Smiseth, {Otto A} and Thor Edvardsen",

year = "2013",

month = aug,

doi = "10.1016/j.jcmg.2013.03.005",

language = "English",

volume = "6",

pages = "841--850",

journal = "J A C C: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier",

number = "8",

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TY - JOUR

T1 - Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction

AU - Haugaa, Kristina H

AU - Grenne, Bjørnar L

AU - Eek, Christian H

AU - Ersbøll, Mads

AU - Valeur, Nana

AU - Svendsen, Jesper H

AU - Florian, Anca

AU - Sjøli, Benthe

AU - Brunvand, Harald

AU - Køber, Lars

AU - Voigt, Jens-Uwe

AU - Desmet, Walter

AU - Smiseth, Otto A

AU - Edvardsen, Thor

PY - 2013/8

Y1 - 2013/8

N2 - Objectives The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI). Background Prediction of ventricular arrhythmias after MI is challenging. Left ventricular ejection fraction (LVEF) <35% is the main parameter for selecting patients for implantable cardioverter- defibrillator therapy. Methods In this prospective, multicenter study, 569 patients >40 days after acute MI were included, 268 of whom had ST-segment elevation MIs and 301 non-ST-segment elevation MIs. By echocardiography, global strain was assessed as average peak longitudinal systolic strain from 16 left ventricular segments. Time from the electrocardiographic R-wave to peak negative strain was assessed in each segment. Mechanical dispersion was defined as the standard deviation from these 16 time intervals, reflecting contraction heterogeneity. Results Ventricular arrhythmias, defined as sustained ventricular tachycardia or sudden death during a median 30 months (interquartile range: 18 months) of follow-up, occurred in 15 patients (3%). LVEFs were reduced (48 ± 17% vs. 55 ± 11%, p < 0.01), global strain was markedly reduced (-14.8 ± 4.7% vs. -18.2 ± 3.7%, p = 0.001), and mechanical dispersion was increased (63 ± 25 ms vs. 42 ± 17 ms, p < 0.001) in patients with arrhythmias compared with those without. Mechanical dispersion was an independent predictor of arrhythmic events (per 10-ms increase, hazard ratio: 1.7; 95% confidence interval: 1.2 to 2.5; p < 0.01). Mechanical dispersion and global strain were markers of arrhythmias in patients with non-ST-segment elevation MIs (p < 0.05 for both) and in those with LVEFs >35% (p < 0.05 for both), whereas LVEF was not (p = 0.33). A combination of mechanical dispersion and global strain showed the best positive predictive value for arrhythmic events (21%; 95% confidence interval: 6% to 46%). Conclusions Mechanical dispersion by strain echocardiography predicted arrhythmic events independently of LVEF in this prospective, multicenter study of patients after MI. A combination of mechanical dispersion and global strain may improve the selection of patients after MI for implantable cardioverter-defibrillator therapy, particularly in patients with LVEFs >35% who did not fulfill current implantable cardioverter-defibrillator indications.

AB - Objectives The aim of this study was to test the hypothesis that strain echocardiography might improve arrhythmic risk stratification in patients after myocardial infarction (MI). Background Prediction of ventricular arrhythmias after MI is challenging. Left ventricular ejection fraction (LVEF) <35% is the main parameter for selecting patients for implantable cardioverter- defibrillator therapy. Methods In this prospective, multicenter study, 569 patients >40 days after acute MI were included, 268 of whom had ST-segment elevation MIs and 301 non-ST-segment elevation MIs. By echocardiography, global strain was assessed as average peak longitudinal systolic strain from 16 left ventricular segments. Time from the electrocardiographic R-wave to peak negative strain was assessed in each segment. Mechanical dispersion was defined as the standard deviation from these 16 time intervals, reflecting contraction heterogeneity. Results Ventricular arrhythmias, defined as sustained ventricular tachycardia or sudden death during a median 30 months (interquartile range: 18 months) of follow-up, occurred in 15 patients (3%). LVEFs were reduced (48 ± 17% vs. 55 ± 11%, p < 0.01), global strain was markedly reduced (-14.8 ± 4.7% vs. -18.2 ± 3.7%, p = 0.001), and mechanical dispersion was increased (63 ± 25 ms vs. 42 ± 17 ms, p < 0.001) in patients with arrhythmias compared with those without. Mechanical dispersion was an independent predictor of arrhythmic events (per 10-ms increase, hazard ratio: 1.7; 95% confidence interval: 1.2 to 2.5; p < 0.01). Mechanical dispersion and global strain were markers of arrhythmias in patients with non-ST-segment elevation MIs (p < 0.05 for both) and in those with LVEFs >35% (p < 0.05 for both), whereas LVEF was not (p = 0.33). A combination of mechanical dispersion and global strain showed the best positive predictive value for arrhythmic events (21%; 95% confidence interval: 6% to 46%). Conclusions Mechanical dispersion by strain echocardiography predicted arrhythmic events independently of LVEF in this prospective, multicenter study of patients after MI. A combination of mechanical dispersion and global strain may improve the selection of patients after MI for implantable cardioverter-defibrillator therapy, particularly in patients with LVEFs >35% who did not fulfill current implantable cardioverter-defibrillator indications.

U2 - 10.1016/j.jcmg.2013.03.005

DO - 10.1016/j.jcmg.2013.03.005

M3 - Journal article

C2 - 23850251

SN - 1936-878X

VL - 6

SP - 841

EP - 850

JO - J A C C: Cardiovascular Imaging

JF - J A C C: Cardiovascular Imaging

IS - 8

ER -

Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction

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