Clinical Utility of Longitudinal Strain to Predict Functional Recovery in Patients With Tachyarrhythmia and Reduced LVEF.

Abstract

OBJECTIVES:

This study sought to assess the time course of presumptive tachycardia-induced cardiomyopathy and the predictors of left ventricular (LV) functional recovery in such patients.

BACKGROUND:

Tachycardia-induced cardiomyopathy is a potentially reversible cardiomyopathy with effective treatment of the tachyarrhythmia. However, cases without improvement of LV systolic function were found occasionally. The diagnosis of tachycardia-induced cardiomyopathy can be challenging, and the role of echocardiographic imaging in the prediction of LV functional recovery is limited.

METHODS:

LV segmental longitudinal strains (LS) were evaluated by 2-dimensional speckle tracking in 71 consecutive patients (65 ± 16 years; 61% men) with tachyarrhythmia and reduced left ventricular ejection fraction (LVEF) without any other known cardiovascular disease, and 30 age and sex-matched control subjects. Relative apical LS ratio (RALSR) was defined using the equation: average apical LS / (average basal LS + average mid LS) as a marker of strain distribution.

RESULTS:

Compared with control subjects, patients with tachyarrhythmia had significantly lower global LS. Improvement in LVEF within 6 months after treatment of index arrhythmia was observed in 41 patients, and LVEF did not improve in 30 patients. In univariate analysis, lower LVEF at baseline (hazard ratio: 0.59 per 1 SD; p = 0.04) and higher RALSR (hazard ratio: 11.2 per 1 SD; p < 0.001) were associated with no recovery in LVEF during follow-up. In a multivariate logistic regression model, the significant predictor of LV systolic functional recovery was RALSR (hazard ratio: 22.9 per 1 SD; p = 0.001). A RALSR of 0.61 was sensitive (71%) and specific (90%) in differentiating LV systolic functional recovery (area under the curve: 0.88).

CONCLUSIONS:

The RALSR was associated with LV systolic functional recovery. This information might be useful for clinical evaluation and follow-up in patients with reduced LVEF.

• Authors: Kenya Kusunose, Yuta Torii, Hirotsugu Yamada, Susumu Nishio, Yukina Hirata, Hiromitsu Seno, Yoshihito Saijo, Takayuki Ise, Koji Yamaguchi, Takeshi Tobiume, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata
• Journal: JACC. Cardiovascular imaging (JACC Cardiovasc Imaging) Vol. 10 Issue 2 Pg. 118-126 (02 2017) ISSN: 1876-7591 [Electronic] United States
• PMID: 27665160 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Area Under Curve
• Arrhythmias, Cardiac (complications, diagnosis, physiopathology, therapy)
• Biomechanical Phenomena
• Cardiomyopathies (diagnostic imaging, etiology, physiopathology)
• Case-Control Studies
• Echocardiography
• Female
• Humans
• Male
• Middle Aged
• Myocardial Contraction
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Recovery of Function
• Reproducibility of Results
• Stress, Mechanical
• Stroke Volume
• Treatment Outcome
• Ventricular Dysfunction, Left (diagnostic imaging, etiology, physiopathology)
• Ventricular Function, Left