Reduced inferior wall longitudinal strain is associated with malignant arrhythmias in non‐ischemic heart failure

• Published in: Pacing and clinical electrophysiology Vol. 46; no. 7; pp. 721 - 728
• Main Authors: Winsløw, Ulrik, Elming, Marie Bayer, Thune, Jens Jakob, Haarbo, Jens, Thornvig Philbert, Berit, Svendsen, Jesper Hastrup, Pehrson, Steen, Jøns, Christian, Bundgaard, Henning, Køber, Lars, Risum, Niels
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2023
• Subjects: Arrhythmia; Arrhythmias, Cardiac; Cardiac arrhythmia; Congestive heart failure; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Echocardiography; Female; global longitudinal strain; Heart failure; Heart Failure - complications; Humans; implantable cardioverter‐defibrillator; Ischemia; left ventricular ejection fraction; Male; mechanical deformation; Middle Aged; myocardial strain; Predictive Value of Tests; regional deformation; Risk Factors; Stroke Volume; sudden cardiac death; Ventricle; ventricular arrhythmia; Ventricular Dysfunction, Left; Ventricular Function, Left; global longitudinal strain; ventricular arrhythmia; regional deformation; left ventricular ejection fraction; mechanical deformation; myocardial strain; sudden cardiac death; implantable cardioverter-defibrillator
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14706

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.