What question did this study set out to answer?

To evaluate left ventricular global longitudinal strain and mechanical dispersion using speckle tracking echocardiography in patients with hypertrophic cardiomyopathy or Anderson-Fabry disease, and assess their association with ventricular arrhythmias.

March 1, 2023European Heart Journal OpenOpen Access

Speckle tracking echocardiography-derived parameters as new prognostic markers in hypertrophic cardiomyopathies

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Why the study?

Mechanical dispersion by STE was suggested as an arrhythmic risk marker, prompting evaluation of LV-GLS and mechanical dispersion in HCM and Anderson-Fabry disease cardiomyopathy and their association with ventricular arrhythmias.

Are speckle tracking echocardiography-derived parameters (LV-GLS and MD) associated with ventricular arrhythmias in patients with hypertrophic cardiomyopathies?

Key Points

To evaluate left ventricular global longitudinal strain and mechanical dispersion using speckle tracking echocardiography in patients with hypertrophic cardiomyopathy or Anderson-Fabry disease, and assess their association with ventricular arrhythmias.
Evaluated 40 patients with hypertrophic cardiomyopathy, 57 with Anderson-Fabry disease (12 with left ventricular hypertrophy, 45 without), and 40 healthy control subjects between January 2014 and June 2022.
Conducted comprehensive echocardiography to measure left ventricular global longitudinal strain (LV-GLS) and mechanical dispersion (MD), alongside Holter-EKG monitoring for ventricular arrhythmias in hypertrophic patients.
Patients experiencing ventricular arrhythmias demonstrated significantly lower LV-GLS (median -10.2% vs. -14%, P = 0.038) and significantly higher MD (85.5 ms vs. 61.1 ms, P = 0.004) compared to those without arrhythmias.
Binary logistic regression showed mechanical dispersion was significantly associated with ventricular arrhythmias (OR 1.030, 95% CI 1.003–1.058, P = 0.03).

Structured PICO

Are speckle tracking echocardiography-derived parameters (LV-GLS and MD) associated with ventricular arrhythmias in patients with hypertrophic cardiomyopathies?

Population

137 subjects including 40 patients with hypertrophic cardiomyopathy (HCM), 57 with Anderson-Fabry disease (AFD) (12 with LV hypertrophy and 45 without), and 40 healthy subjects.

Intervention

Speckle tracking echocardiography (STE) to measure left ventricle global longitudinal strain (LV-GLS) and mechanical dispersion (MD).

Outcome

Association of LV-GLS and MD with ventricular arrhythmias (V-AR) including ventricular fibrillation and sustained/non-sustained ventricular tachycardia.surrogate

Mechanical dispersion measured by speckle tracking echocardiography is associated with ventricular arrhythmias in patients with hypertrophic cardiomyopathies, suggesting its potential as a prognostic marker for arrhythmic risk.

Implication

MD may support arrhythmic risk stratification in HCM; hypothesis-generating and requires prospective validation.

Abstract

Aims Hypertrophic cardiomyopathies (HCM) are caused in 30–60% of cases by mutations in cardiac sarcomere genes but can also be an expression of cardiac involvement in multi-systemic metabolic diseases, such as Anderson–Fabry disease (AFD). HCM entails a risk of sudden cardiac death (SCD) of 0.9%/year and is the most common cause of SCD in young adults. Recent studies suggested mechanical dispersion (MD) by speckle tracking echocardiography (STE) as an additional arrhythmic risk marker. The aim of the study was to evaluate left ventricle global longitudinal strain (LV-GLS) and MD, in patients with HCM or AFD cardiomyopathy, and the association with ventricular arrhythmias (V-AR). Methods and results We evaluated 40 patients with HCM, 57 with AFD (12 with LV hypertrophy and 45 without), and 40 healthy subjects, between January 2014 and June 2022. We performed a comprehensive echocardiographic study and analysed systolic and diastolic functions, LV-GLS, and MD. We also analysed V-AR, including ventricular fibrillation and sustained/non-sustained ventricular tachycardia, by Holter electrocardiogram (Holter-EKG), in a subset of hypertrophic patients. Data were analysed by unpaired Student t-test or chi-square/Fisher’s exact test as appropriate and binary logistic regression (SPSS Statistics ver.26). LV-GLS was significantly lower in the V-AR group compared with patients without V-AR (median −10.2% vs. −14%, P = 0.038); MD was significantly higher in the V-AR group (85.5 ms vs. 61.1 ms, P = 0.004). V-AR were found significantly associated with MD (OR, 1.030; 95% CI, 1.003–1.058; P = 0.03). Conclusions MD is a useful additional index in the evaluation of patients with HCM and may be a promising prognostic predictor of increased arrhythmic risk.