Exhausted atrial reserve by tissue Doppler echocardiography: a risk marker in heart failure with reduced ejection fraction.

Abstract

Implantable cardioverter defibrillators (ICDs) are widely used in the prevention of ventricular arrhythmias and their efficiency to prolong life is well documented in long-term follow-up studies. On the other hand, defibrillators may cause complications, and as shown recently, the 12-year cumulative incidence of adverse events was 20% for inappropriate shock, 6% for device-related infection, and 17% for lead failure.1 Furthermore, a large fraction of patients with an ICD implant never receive appropriate shock therapy.2,3 As stated in the article by Biering-Sorensen et al .,4 there is a need for further refinement of selection criteria for ICD. Traditionally, left ventricular (LV) ejection fraction (EF) is used as a measure of LV systolic function, and is so far the only measure of LV contractile function which is incorporated into clinical practice guidelines for treatment with ICD.5 However, the ability of EF to predict outcome is limited, and supplementary or alternative methods to quantify LV function are needed.6 The study of Biering-Sorensen et al .4 investigated the ability of tissue Doppler imaging to predict ventricular tachycardia, ventricular fibrillation, and cardiovascular mortality in patients with ischaemic cardiomyopathy who received ICD as primary prevention. They showed that global mitral annular velocity during atrial contraction (a′) was an independent predictor, and events were four times more common in the lowest quartile of a′ than in the highest. Neither LVEF nor other …