Abstract 2847: Role of Peri-infarct Zone Detected With Two-Dimensional Speckle Tracking Echocardiography on Ventricular Arrhythmia Inducibility in Patients With Chronic Ischemic Cardiomyopathy
Objective. The characterization of arrhythmogenic myocardial substrate in patients with previous myocardial infarction (MI) is challenging and may be a useful risk-stratification tool in these patients. Therefore, the aim of this study was to determine if the function and extent of peri-infarct zone as assessed by speckle-tracking echocardiography were related to inducibility of ventricular arrhythmias in patients with previous MI.
Methods. A total of 119 patients with previous MI referred for cardiac electrophysiological (EP) study were included. All patients underwent extensive clinical and echocardiographic evaluations immediately prior to EP study. Echocardiographic speckle-tracking analysis using automated function imaging was applied to assess global and segmental longitudinal peak systolic strain. An infarct segment was defined as a longitudinal strain value of >-5%. A peri-infarct segment was defined as immediately adjacent to an infarct segment. A remote segment was defined as any segment that was not an infarct or peri-infarct segment. A positive EP study was defined as induction of sustained monomorphic ventricular tachycardia (MVT).
Results. The mean age was 68±10 years, 106 men. Mean LVEF was 31±9%. Mean longitudinal strain of the peri-infarct zone was more impaired in inducible (n=30) versus non-inducible (n=89) patients (−9.6±1.4% vs. −11.3±2.5%, respectively, p<0.001), whereas there were no significant differences in global, infarct and remote longitudinal strains. Furthermore, inducible patients had significantly higher number of peri-infarct segments as compared to non-inducible patients (6.5±1.9 vs. 5.0±1.8, respectively, p<0.001). After analyzing all clinical and echocardiographic variables, only longitudinal strain of the peri-infarct zone (odds ratio 1.96, 95%confidence intervals 1.32–2.89, p=0.001) and the number of peri-infarct segments (odds ratio 1.60, 95%confidence intervals 1.14–2.26, p=0.007) were independent determinants of MVT inducibility on multiple logistic regression analysis.
Conclusions. The function and extent of the peri-infarct zone as assessed by speckle-tracking echocardiography are important determinants of MVT inducibility in patients with previous MI.