Advanced Echocardiographic Imaging for Prediction of SCD in Moderate and Severe LV Systolic Function

Rebecca Perry, Sanjana Patil, Christian Marx, Matthew Horsfall, Derek Chew, Karthigesh Sree Raman, Noor Darinah Mohd Daril, Kathryn Tiver, Majo X. Joseph, Anand Ganesan, Andrew McGavigan, Gaetano Nucifora, Joseph Selvanayagam

Research output: Contribution to journalArticle

Abstract

Objectives: This study sought to determine the long-term prognostic value of myocardial deformation imaging by echocardiography in risk stratification of sudden cardiac death (SCD) and malignant ventricular arrhythmias (VAs) in a large consecutive cohort of patients with left ventricular (LV) systolic impairment, irrespective of its etiology. Background: Left ventricular ejection fraction (LVEF) is limited for prediction of SCD. Echocardiographic strain-derived mechanical dispersion (MD) and global longitudinal strain (GLS) has been linked to VA and SCD. However, due to low event rates, the role of these parameters has not been fully elucidated. Methods: Consecutive clinically stable patients who underwent echocardiographic study performed in an outpatient setting from 2008 to 2014 with a Simpson left ventricular ejection fraction (LVEF) ≤45% were included in the study. Strain analysis was performed in which the LV was separated into 16 segments for regional analysis. Mechanical dispersion (MD) was calculated as the standard deviation of the time to peak of each of the 16 regions. Outcome data were obtained from medical records. Results: A total of 939 patients were included in the study, with median LVEF of 37% (interquartile range 30% to 42%). At follow-up (91.4 ± 23.4 months), 96 VA events had occurred. Multivariate analysis demonstrated that only MD ≥75 ms (hazard ratio: 9.45; 95% confidence interval: 4.75 to 18.81; p < 0.0001) was predictive of VA events. Low MD predicted a low event rate, irrespective of LVEF. Conclusions: Using LVEF alone is inferior for prediction of VA and SCD, particularly in patients with moderately reduced LVEF. MD is easily obtained from standard echocardiographic images and can be used to improve risk prognosis, particularly in patients who are currently excluded from cardiac defibrillator implantation based on LVEF.

LanguageEnglish
JournalJACC: Cardiovascular Imaging
DOIs
Publication statusPublished - 11 Oct 2019

Keywords

  • echocardiography
  • mechanical dispersion
  • sudden cardiac death

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Perry, Rebecca ; Patil, Sanjana ; Marx, Christian ; Horsfall, Matthew ; Chew, Derek ; Sree Raman, Karthigesh ; Daril, Noor Darinah Mohd ; Tiver, Kathryn ; Joseph, Majo X. ; Ganesan, Anand ; McGavigan, Andrew ; Nucifora, Gaetano ; Selvanayagam, Joseph. / Advanced Echocardiographic Imaging for Prediction of SCD in Moderate and Severe LV Systolic Function. In: JACC: Cardiovascular Imaging. 2019.
@article{f17446c4bd6b400cb68b4458243e6076,
title = "Advanced Echocardiographic Imaging for Prediction of SCD in Moderate and Severe LV Systolic Function",
abstract = "Objectives: This study sought to determine the long-term prognostic value of myocardial deformation imaging by echocardiography in risk stratification of sudden cardiac death (SCD) and malignant ventricular arrhythmias (VAs) in a large consecutive cohort of patients with left ventricular (LV) systolic impairment, irrespective of its etiology. Background: Left ventricular ejection fraction (LVEF) is limited for prediction of SCD. Echocardiographic strain-derived mechanical dispersion (MD) and global longitudinal strain (GLS) has been linked to VA and SCD. However, due to low event rates, the role of these parameters has not been fully elucidated. Methods: Consecutive clinically stable patients who underwent echocardiographic study performed in an outpatient setting from 2008 to 2014 with a Simpson left ventricular ejection fraction (LVEF) ≤45{\%} were included in the study. Strain analysis was performed in which the LV was separated into 16 segments for regional analysis. Mechanical dispersion (MD) was calculated as the standard deviation of the time to peak of each of the 16 regions. Outcome data were obtained from medical records. Results: A total of 939 patients were included in the study, with median LVEF of 37{\%} (interquartile range 30{\%} to 42{\%}). At follow-up (91.4 ± 23.4 months), 96 VA events had occurred. Multivariate analysis demonstrated that only MD ≥75 ms (hazard ratio: 9.45; 95{\%} confidence interval: 4.75 to 18.81; p < 0.0001) was predictive of VA events. Low MD predicted a low event rate, irrespective of LVEF. Conclusions: Using LVEF alone is inferior for prediction of VA and SCD, particularly in patients with moderately reduced LVEF. MD is easily obtained from standard echocardiographic images and can be used to improve risk prognosis, particularly in patients who are currently excluded from cardiac defibrillator implantation based on LVEF.",
keywords = "echocardiography, mechanical dispersion, sudden cardiac death",
author = "Rebecca Perry and Sanjana Patil and Christian Marx and Matthew Horsfall and Derek Chew and {Sree Raman}, Karthigesh and Daril, {Noor Darinah Mohd} and Kathryn Tiver and Joseph, {Majo X.} and Anand Ganesan and Andrew McGavigan and Gaetano Nucifora and Joseph Selvanayagam",
year = "2019",
month = "10",
day = "11",
doi = "10.1016/j.jcmg.2019.07.026",
language = "English",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",

}

Advanced Echocardiographic Imaging for Prediction of SCD in Moderate and Severe LV Systolic Function. / Perry, Rebecca; Patil, Sanjana; Marx, Christian; Horsfall, Matthew; Chew, Derek; Sree Raman, Karthigesh; Daril, Noor Darinah Mohd; Tiver, Kathryn; Joseph, Majo X.; Ganesan, Anand; McGavigan, Andrew; Nucifora, Gaetano; Selvanayagam, Joseph.

In: JACC: Cardiovascular Imaging, 11.10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Advanced Echocardiographic Imaging for Prediction of SCD in Moderate and Severe LV Systolic Function

AU - Perry, Rebecca

AU - Patil, Sanjana

AU - Marx, Christian

AU - Horsfall, Matthew

AU - Chew, Derek

AU - Sree Raman, Karthigesh

AU - Daril, Noor Darinah Mohd

AU - Tiver, Kathryn

AU - Joseph, Majo X.

AU - Ganesan, Anand

AU - McGavigan, Andrew

AU - Nucifora, Gaetano

AU - Selvanayagam, Joseph

PY - 2019/10/11

Y1 - 2019/10/11

N2 - Objectives: This study sought to determine the long-term prognostic value of myocardial deformation imaging by echocardiography in risk stratification of sudden cardiac death (SCD) and malignant ventricular arrhythmias (VAs) in a large consecutive cohort of patients with left ventricular (LV) systolic impairment, irrespective of its etiology. Background: Left ventricular ejection fraction (LVEF) is limited for prediction of SCD. Echocardiographic strain-derived mechanical dispersion (MD) and global longitudinal strain (GLS) has been linked to VA and SCD. However, due to low event rates, the role of these parameters has not been fully elucidated. Methods: Consecutive clinically stable patients who underwent echocardiographic study performed in an outpatient setting from 2008 to 2014 with a Simpson left ventricular ejection fraction (LVEF) ≤45% were included in the study. Strain analysis was performed in which the LV was separated into 16 segments for regional analysis. Mechanical dispersion (MD) was calculated as the standard deviation of the time to peak of each of the 16 regions. Outcome data were obtained from medical records. Results: A total of 939 patients were included in the study, with median LVEF of 37% (interquartile range 30% to 42%). At follow-up (91.4 ± 23.4 months), 96 VA events had occurred. Multivariate analysis demonstrated that only MD ≥75 ms (hazard ratio: 9.45; 95% confidence interval: 4.75 to 18.81; p < 0.0001) was predictive of VA events. Low MD predicted a low event rate, irrespective of LVEF. Conclusions: Using LVEF alone is inferior for prediction of VA and SCD, particularly in patients with moderately reduced LVEF. MD is easily obtained from standard echocardiographic images and can be used to improve risk prognosis, particularly in patients who are currently excluded from cardiac defibrillator implantation based on LVEF.

AB - Objectives: This study sought to determine the long-term prognostic value of myocardial deformation imaging by echocardiography in risk stratification of sudden cardiac death (SCD) and malignant ventricular arrhythmias (VAs) in a large consecutive cohort of patients with left ventricular (LV) systolic impairment, irrespective of its etiology. Background: Left ventricular ejection fraction (LVEF) is limited for prediction of SCD. Echocardiographic strain-derived mechanical dispersion (MD) and global longitudinal strain (GLS) has been linked to VA and SCD. However, due to low event rates, the role of these parameters has not been fully elucidated. Methods: Consecutive clinically stable patients who underwent echocardiographic study performed in an outpatient setting from 2008 to 2014 with a Simpson left ventricular ejection fraction (LVEF) ≤45% were included in the study. Strain analysis was performed in which the LV was separated into 16 segments for regional analysis. Mechanical dispersion (MD) was calculated as the standard deviation of the time to peak of each of the 16 regions. Outcome data were obtained from medical records. Results: A total of 939 patients were included in the study, with median LVEF of 37% (interquartile range 30% to 42%). At follow-up (91.4 ± 23.4 months), 96 VA events had occurred. Multivariate analysis demonstrated that only MD ≥75 ms (hazard ratio: 9.45; 95% confidence interval: 4.75 to 18.81; p < 0.0001) was predictive of VA events. Low MD predicted a low event rate, irrespective of LVEF. Conclusions: Using LVEF alone is inferior for prediction of VA and SCD, particularly in patients with moderately reduced LVEF. MD is easily obtained from standard echocardiographic images and can be used to improve risk prognosis, particularly in patients who are currently excluded from cardiac defibrillator implantation based on LVEF.

KW - echocardiography

KW - mechanical dispersion

KW - sudden cardiac death

UR - http://www.scopus.com/inward/record.url?scp=85073223542&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2019.07.026

DO - 10.1016/j.jcmg.2019.07.026

M3 - Article

JO - JACC: Cardiovascular Imaging

T2 - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

ER -