Abstract 18269: Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Heart Failure Patients With Reduced Ejection Fraction - A MADIT-CRT Sub-Study

Abstract

Background: Abnormalities of regional function are known predictors of ventricular arrhythmia. We assessed whether measures of regional longitudinal deformation by speckle tracking echocardiography improve prediction of ventricular tachyarrhythmias over clinical, echocardiography parameters, or biomarkers. Methods: We studied 1064 patients enrolled in MADIT-CRT with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior and inferior myocardial walls. The endpoint was the first event of ventricular tachycardia (VT) or fibrillation (VF). Results: During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower LVEF (28.3% vs 29.5%, p<0.001) and longitudinal strain in all myocardial walls compared to patients without VT/VF (Figure). After multivariate adjustment for clinical and conventional echocardiographic predictors of VT/VF, only longitudinal strain in the anterior and inferior myocardial walls remained independent predictors of VT/VF (anterior: HR 1.08 [1.03; 1.13], p=0.001; inferior: HR 1.08 [1.04; 1.12], p<0.001; per 1% increase for both). After including BNP in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (HR 1.05 [1.00; 1.10], p<0.05) (Figure). Additionally, only strain in the inferior myocardial wall provided incremental prognostic information on the risk of VT/VF when added to a model already including clinical parameters and LVEF, determined by a significant increase in the Harrell’s C-statistic (0.70 vs 0.67, p=0.002). Conclusion: In MADIT-CRT, assessment of regional longitudinal myocardial deformation in the inferior myocardial wall provided incremental prognostic information over clinical, conventional echocardiographic risk factors, or biomarkers in predicting ventricular tachyarrhythmias.