Key result
Reduced inferior wall longitudinal strain is linked to ~150% higher arrhythmic risk in non-ischemic HF.
Why the study?
Reduced systolic myocardial function in the inferior region of the left ventricle has been suggested to be associated with malignant arrhythmias, but this hypothesis needed testing in non-ischemic heart failure.
Does reduced inferior wall longitudinal strain predict malignant arrhythmias and sudden cardiac death in patients with non-ischemic heart failure?
Cohort (n=401)
Yes
Does reduced inferior wall longitudinal strain predict malignant arrhythmias and sudden cardiac death in patients with non-ischemic heart failure?
Reduced inferior wall longitudinal strain assessed by 2D-speckle-tracking echocardiography is an independent predictor of malignant arrhythmias and sudden cardiac death in patients with non-ischemic heart failure.
May refine arrhythmia risk stratification beyond LVEF in non-ischemic HF; extends regional strain observations but remains hypothesis-generating.
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.
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Winsløw et al. (2023) conducted a cohort in Non-ischemic heart failure (n=401). Reduced inferior wall longitudinal strain vs. High inferior wall longitudinal strain was evaluated on Composite of sudden cardiac death, admission with sustained ventricular arrhythmia, resuscitated cardiac arrest, and appropriate therapy from a primary prophylactic implantable cardioverter defibrillator (HR 2.50, 95% CI 1.35-4.62, p=0.003). Reduced inferior wall longitudinal strain was independently associated with a 2.5-fold increased risk of malignant arrhythmias and sudden cardiac death (HR 2.50) in patients with non-ischemic heart failure.
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