Key result
A 5% absolute GLS decrease is linked to ~228% higher appropriate ICD therapy risk in CAD.
Why the study?
Left ventricular ejection fraction has not demonstrated reliability in predicting ventricular arrhythmias or appropriate implantable cardioverter defibrillator therapy.
Does left ventricular global longitudinal strain predict appropriate ICD therapy in patients with primary prevention defibrillators?
Cohort (n=178)
Does left ventricular global longitudinal strain predict appropriate ICD therapy in patients with primary prevention defibrillators?
Effect estimate: HR 3.28 (95% CI 1.46-7.36)
Reduced left ventricular global longitudinal strain is an independent predictor of appropriate ICD therapy in patients with coronary artery disease and primary prevention defibrillators.
GLS may refine arrhythmia risk stratification beyond LVEF in CAD patients with primary-prevention ICDs; leaves open prospective validation before practice change.
Background Left ventricular ejection fraction (LVEF) has not demonstrated reliability in predicting ventricular arrhythmias or appropriate implantable cardioverter defibrillator (ICD) therapy (AICDt). Objective To evaluate the association between left ventricular global longitudinal strain (GLS) and AICDt. Methods One hundred seventy‐eight consecutive patients who received ICD implants for primary prevention of sudden cardiac death from 1/16/2015 to 1/26/2022 were followed until 1st appropriate ICD therapy (AICDt) for a ventricular arrhythmia, death, or loss to follow‐up. AICDt were physician adjudicated. Covariates included demographic variables (age, sex), clinical risk factors (LVEF, cardiac resynchronization therapy, coronary artery disease, anti‐arrhythmic drug use, QRS duration), and variables from the DO‐IT model (nonsustained ventricular tachycardia, atrial fibrillation, glomerular filtration rate, peripheral vascular disease, direct oral anticoagulant use, digoxin use, aldosterone antagonist use, and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker use). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI 95 ) of GLS per 5% decrease (absolute value) for AICDt. Results Over a mean (standard deviation) follow up period of 5.09 (2.11) years, 44 of the 178 patients (79.77% male, 63.89 (12.89) years of age) in the final cohort experienced AICDt. In patients with coronary artery disease, GLS per 5% decrease (absolute value) was associated with AICDt independent of demographic variables (HR 2.16, CI 95 1.09–4.27), clinical risk factors (HR 2.54, CI 95 1.16–5.59), and variables from the DO‐IT model (HR 3.28, CI 95 1.46–7.36). Conclusion Reduced GLS (absolute value) is an independent risk factor for AICDt in patients with coronary artery disease.
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Rackley et al. (2026) conducted a cohort in Primary prevention of sudden cardiac death with ICD (n=178). Left ventricular global longitudinal strain (GLS) was evaluated on First appropriate ICD therapy (AICDt) for a ventricular arrhythmia (HR 3.28, 95% CI 1.46-7.36). A 5% absolute decrease in global longitudinal strain was independently associated with appropriate ICD therapy in patients with coronary artery disease (HR 3.28; 95% CI 1.46-7.36).
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