Mechanical Dispersion as a Predictor of Arrhythmic Death in Patients with Ischaemic and Non-Ischaemic Left Ventricular Dysfunction - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Vincenzo Nissardi Department of Emergency, Azienda Ospedaliero-Universitaria - Cagliari. Cardiology Clinic, Cagliari, Italy/Cagliari, Italy Roberta Montisci Department of Emergency, Azienda Ospedaliero-Universitaria - Cagliari. Cardiology Clinic, Cagliari, Italy/Cagliari, Italy Cinzia Soro Department of Emergency, Azienda Ospedaliero-Universitaria - Cagliari. Cardiology Clinic, Cagliari, Italy/Cagliari, Italy Roberto Floris Department of Emergency, Azienda Ospedaliero-Universitaria - Cagliari. Cardiology Clinic, Cagliari, Italy/Cagliari, Italy Giancarlo Molle Department of Emergency, Azienda Ospedaliero-Universitaria - Cagliari. Cardiology Clinic, Cagliari, Italy/Cagliari, Italy Luigi Meloni Department of Emergency, Azienda Ospedaliero-Universitaria - Cagliari. Cardiology Clinic, Cagliari, Italy/Cagliari, Italy

Background; ICD is a cost-effective treatment in the primary/secondary prevention of ventricular arrhythmia (VA) in patients with ischaemic/non-ischaemic cardiomyopathy. The decision to implant an ICD is currently based on clinical history, NYHA class, left ventricular ejection fraction (LVEF) and life expectancy. Myocardial strain assessed using speckle tracking echocardiography represents a novel tool to quantify global and regional myocardial function. The aim of our study was to evaluate the correlation between myocardial strain and VA in patients treated with ICD.

Methods: We recruited 48 patients with ischaemic/non-ischaemic cardiomyopathy (39 males), middle aged (63.7 years), implanted with ICD or CRT-D in primary (34 pts) and secondary (14 pts) prevention. Each patient underwent clinical examination, ECG, transthoracic echocardiography and speckle tracking (Global Longitudinal Strain , GLS, Mechanical Dispersion, MD) and device interrogation. During the FU life-threatening VA occurred in 16 patients (events group). No difference of age, gender, cardiovascular risk factors and etiology were observed. LVEF, wall motion score index and GLS were comparable between the two groups. Event group exhibited a higher MD ( 112.7 ± 33 vs. 68.5 ± 30.8 msec, p = 0.0001), we found a linear correlation between the MD value and VA (r=-0,56, p=0.0001). From the ROC curves analysis, a MD value ≥ 103 msec was a best predictor of VA (sensitivity 63%, specificity 94%,). At multivariate analysis, only a MD of 103 msec had an independent predictive value of VA (HR 6.6, p = 0.006). The correlation between VA and MD was confirmed in both ischaemic/non-ischaemic patients (r=0.61, p=0.001 e r=0.48, p=0.0178 respectively). A MD value ≥103 msec has been found to be a predictor of VA in the two groups (p=0.012 and p=0.015,respectively).

Conclusions: MD evaluated using speckle tracking technique is a valid toll for risk stratification of VA in patients with ischaemic/non-ischaemic cardiomyopathy.