Abstract 14898: Prognostic Value of Tissue Doppler Imaging for Predicting Ventricular Arrhythmias and Cardiovascular Mortality in Ischemic Cardiomyopathy

Abstract

Background: Only 30% of patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention respond appropriately to this therapy. The purpose of this study was to investigate the value of Tissue Doppler Imaging (TDI) Echocardiography at predicting appropriate ICD therapy and cardiovascular mortality (CVD) in patients with primary prevention ICD. Methods: In total, 151 ICD patients meeting primary prevention criteria, with no history of ventricular arrhythmias were included. All participants were examined by conventional 2D echocardiography and TDI echocardiography. Longitudinal systolic (s’), early diastolic (e’), and late diastolic (a’) myocardial velocities were measured using TDI at six mitral annular sites and averaged to provide global estimates. Results: Forty patients experienced the combined endpoint of ventricular tachycardia (VT), fibrillation (VF) or CVD during a median follow-up of 2.3 years. Neither left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), E/e’, global s’ nor global e’ were significantly impaired in patients who developed VT/VF/CVD (LVEF: 31 vs. 28 %, p=0.06; GLS: 9 vs. 9 %, p=0.85; E/e’: 16 vs. 16, p=0.80; s’: 3.8 vs. 3.7 cm/s, p=0.68; e’: 4.5 vs. 4.6 cm/s, p=0.61). In contrast, global a’ was significantly lower in patients with an unfavorable outcome compared to those without (5.7±1.8 vs. 4.8±2.0 cm/s, p=0.020). Global a’ remained an independent predictor of VT/VF/CVD after multivariable adjustment for age, gender, beta blocker therapy and deceleration time (HR=1.25 [1.02; 1.54], p=0.032). Regional analysis revealed that a depressed a’ in the inferior wall drives the predictive capability of a’ (Figure). Conclusion: Late diastolic velocity by TDI seems to be a superior echocardiographic predictor of VT/VF/CVD in ischemic cardiomyopathy. Additionally, impaired late diastolic velocity in the inferior myocardial wall seems to be a paramount marker of future VT/VF/CVD.