Reduced inferior wall longitudinal strain is associated with malignant arrhythmias in non-ischemic heart failure
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Background: Reduced systolic myocardial function in the inferior region of the left ventricle has been suggested to be associated with malignant arrhythmias. We tested this hypothesis in patients with non-ischemic heart failure. Methods: Patients with non-ischemic heart failure (left ventricular ejection fraction [LVEF] < 35%) were evaluated by 2D-speckle-tracking echocardiography. The regional longitudinal strain was calculated for each of the six left ventricular walls. The reduced regional function was defined as strain below the median. The outcome was a composite of sudden cardiac death, admission with sustained ventricular arrhythmia, resuscitated cardiac arrest, and appropriate therapy from a primary prophylactic implantable cardioverter defibrillator. Time-to-first-event analysis was performed using a Cox model. Results: From two centers, 401 patients were included (median age: 63 years, 72% male) with a median LVEF of 25% (interquartile range [IQR] 20;30), and a median inferior wall strain of –9.0% (–12.5; –5.4). During a median follow-up of 4.0 years, 52 outcomes occurred. After multivariate adjustment for clinical and electrocardiographic parameters, inferior wall strain was independently associated with the outcome (HR 2.50 [1.35; 4.62], p =.003). No independent association was found between the composite outcome and reduced strain in any of the other left ventricular walls, Global Longitudinal Strain (HR 1.66 [0.93; 2.98], p =.09), or LVEF (HR 1.33 [0.75; 2.33], p =.33). Conclusions: Below median strain in the left ventricular inferior region was independently associated with a 2.5-fold increase in the risk of malignant arrhythmias and sudden cardiac death in patients with non-ischemic heart failure.
Originalsprog | Engelsk |
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Tidsskrift | PACE - Pacing and Clinical Electrophysiology |
Vol/bind | 46 |
Udgave nummer | 7 |
Sider (fra-til) | 721-728 |
Antal sider | 8 |
ISSN | 0147-8389 |
DOI | |
Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
The DANISH trial was supported by grants from Medtronic and St Jude Medical. The funders had no role in designing the study, data analysis, or in interpretation of the results. The funders further were not involved in the decision to publish.
Publisher Copyright:
© 2023 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.
ID: 368801677