Coronary artery disease, poor global longitudinal strain, and prolonged mechanical dispersion were associated with a 17.2-fold increased risk of sudden cardiac arrest in patients with preserved LVEF.
Case-Control (n=600)
Do echocardiographic strain indices (GLS and MD) improve sudden cardiac arrest risk stratification beyond coronary artery disease in patients with preserved LVEF?
Echocardiographic strain indices (GLS and MD) significantly enhance risk stratification for sudden cardiac arrest beyond coronary artery disease in patients with preserved ejection fraction.
Effect estimate: 17.2-fold risk
Abstract Background Sudden cardiac arrest (SCA) in patients with preserved left ventricular ejection fraction (LVEF ≥50%) without overt left ventricular hypertrophy is challenging for prevention. While coronary artery disease (CAD) is a known risk factor, echocardiographic parameters such as global longitudinal strain (GLS) and mechanical dispersion (MD) could contribute to risk stratification. Purpose We sought to evaluate GLS and MD for SCA risk stratification in patients with preserved LVEF, and to assess how these echocardiographic markers interact with the presence of CAD. Methods Echocardiograms of patients who were evaluated in the electrophysiology clinic were reviewed consecutively from 2017 to 2022. Among 600 patients who met the study inclusion criteria, we defined patients who suffered from SCA during follow up and compared them with age- and sex-matched subjects from the study cohort in 1:2 ratio. Left ventricular GLS was obtained from 16 segments by using speckle-tracking strain and MD was computed as the standard deviation of time-to-peak strain of 16 segments. CAD was defined 50% stenosis in any proximal or mid coronary artery. SCA events were noted over 5 years. Results Youden cut-offs were defined as -14.1% for GLS and 75.4ms for MD as indicators SCA risk. Figure 1 presents the distribution of CAD, poor GLS (-14.1%)and prolonged MD (75.4 ms) in the subgroups with and without SCA. In this specific cohort with preserved LVEF (Table), derived from the EP clinic, the risk of SCA was found to be 5.8 fold in the presence of CAD, 12.7 fold in the presence of both CAD and poor GLS and 17.2 fold in the presence of CAD, poor GLS, and prolonged MD (Figure 2) over 5 years of follow-up (median 32 months, range 31-57). Conclusion MD and GLS have added value to CAD for risk stratification in patients with preserved LVEF who are evaluated in the electrophysiology clinic for ventricular ectopic beats. An integrated risk stratification model may enhance early identification of the risk for SCA in non-cardiomyopathic phenotypes with preserved LVEF. Figure 1 and 2
Ozbay et al. (Thu,) conducted a case-control in Preserved left ventricular ejection fraction (LVEF ≥50%) (n=600). Coronary artery disease, poor global longitudinal strain, and prolonged mechanical dispersion vs. Absence of these risk factors was evaluated on Sudden cardiac arrest (17.2-fold risk). Coronary artery disease, poor global longitudinal strain, and prolonged mechanical dispersion were associated with a 17.2-fold increased risk of sudden cardiac arrest in patients with preserved LVEF.