Key result
Speckle-tracking longitudinal strain strongly correlates with electroanatomic mapping scar percentage in NICM patients.
Why the study?
Longitudinal strain corresponds to scar in ischemic cardiomyopathy, but whether regional abnormalities correlate with scar location and burden identified by electroanatomic mapping in nonischemic cardiomyopathy was unclear.
Does speckle-tracking echocardiography-derived longitudinal strain predict electroanatomic scar location and burden in patients with nonischemic cardiomyopathy and ventricular tachycardia?
Observational (n=50)
Does speckle-tracking echocardiography-derived longitudinal strain predict electroanatomic scar location and burden in patients with nonischemic cardiomyopathy and ventricular tachycardia?
Effect estimate: r = 0.72-0.82
p-value: p=<.001
Speckle-tracking echocardiography-derived longitudinal strain strongly correlates with electroanatomic mapping scar location and burden, suggesting its utility as a noninvasive tool for pre-procedural scar localization in nonischemic cardiomyopathy.
May support noninvasive scar localization before VT ablation in nonischemic cardiomyopathy; hypothesis-generating pending prospective validation.
BackgroundLongitudinal strain (LS) derived from speckle-tracking echocardiography (STE) corresponds to regions of scar in ischemic cardiomyopathy.ObjectiveWe investigated if regional LS abnormalities correlate with scar location and scar burden, identified using high-density electroanatomic mapping (EAM) in nonischemic cardiomyopathy (NICM).MethodsFifty NICM patients with ventricular tachycardia (VT) underwent echocardiography; multilayer (endocardial, midmyocardial, and epicardial) regional LS and global LS (GLS) were evaluated prior to EAM for detection of low-voltage scar. Patients were divided into 3 groups by EAM left ventricular scar location: (1) anteroseptal (group 1, n = 20); (2) inferolateral (group 2, n = 20); and (3) epicardial scar (group 3; n = 10). We correlated (1) location of scar to regional LS and (2) regional strain and GLS to scar percentage.ResultsRegional LS abnormalities correlated with EAM scar in all groups. Segmental impaired LS and low voltage on EAM demonstrated concordance with scar in ∼75% or its border zone in 25% of segments. In groups 1 and 2, endocardial GLS showed a strong linear correlation with endocardial bipolar scar percentage (r = 0.79, 0.75 for groups 1 and 2, respectively; P < .001), whereas midmyocardial GLS correlated with unipolar scar percentage (r = 0.82, 0.78 for groups 1 and 2, respectively; P < .001). In group 3, epicardial regional LS and GLS correlated with epicardial bipolar scar percentage (r = 0.72, P < .001).ConclusionRegional abnormalities on LS predict scar location on EAM mapping in patients with NICM. Moreover, global and regional LS correlate with scar percentage. STE could be used as a noninvasive tool for localizing and quantifying scar prior to EAM. Longitudinal strain (LS) derived from speckle-tracking echocardiography (STE) corresponds to regions of scar in ischemic cardiomyopathy. We investigated if regional LS abnormalities correlate with scar location and scar burden, identified using high-density electroanatomic mapping (EAM) in nonischemic cardiomyopathy (NICM). Fifty NICM patients with ventricular tachycardia (VT) underwent echocardiography; multilayer (endocardial, midmyocardial, and epicardial) regional LS and global LS (GLS) were evaluated prior to EAM for detection of low-voltage scar. Patients were divided into 3 groups by EAM left ventricular scar location: (1) anteroseptal (group 1, n = 20); (2) inferolateral (group 2, n = 20); and (3) epicardial scar (group 3; n = 10). We correlated (1) location of scar to regional LS and (2) regional strain and GLS to scar percentage. Regional LS abnormalities correlated with EAM scar in all groups. Segmental impaired LS and low voltage on EAM demonstrated concordance with scar in ∼75% or its border zone in 25% of segments. In groups 1 and 2, endocardial GLS showed a strong linear correlation with endocardial bipolar scar percentage (r = 0.79, 0.75 for groups 1 and 2, respectively; P < .001), whereas midmyocardial GLS correlated with unipolar scar percentage (r = 0.82, 0.78 for groups 1 and 2, respectively; P < .001). In group 3, epicardial regional LS and GLS correlated with epicardial bipolar scar percentage (r = 0.72, P < .001). Regional abnormalities on LS predict scar location on EAM mapping in patients with NICM. Moreover, global and regional LS correlate with scar percentage. STE could be used as a noninvasive tool for localizing and quantifying scar prior to EAM.
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Trivedi et al. (2022) conducted an observational in Nonischemic cardiomyopathy with ventricular tachycardia (n=50). Speckle-tracking echocardiography (longitudinal strain) vs. Electroanatomic mapping (reference standard) was evaluated on Correlation of regional and global longitudinal strain to scar location and scar percentage (r = 0.72-0.82, p=<.001). Longitudinal strain derived from speckle-tracking echocardiography strongly correlated with scar percentage on electroanatomic mapping in nonischemic cardiomyopathy patients (r=0.72-0.82, P<0.001).
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