Abstract 13290: Left Ventricular Strain is Predictive of Ventricular Arrhythmias in ICD and CRT-D Patients - A MADIT-CRT Sub-Study

Abstract

Background. While left ventricular ejection fraction (LVEF) is a known predictor of outcomes in patients with heart failure, strain imaging may offer improved predictive accuracy.

Methods. We assessed the predictive value of strain imaging to predict ventricular arrhythmias in 1064 patients (ICD: n= 416, CRT-D: n=661) enrolled in MADIT-CRT with 2D strain analysis available at baseline and at 12-months (n=810). Global longitudinal strain (GLS) was assessed by speckle tracking echocardiography and related to ventricular tachycardia (VT), ventricular fibrillation (VF) or death and VT/VF.

Results: GLS at baseline (categorized by Q1: GLS<-10.6) was predictive of VT/VF/Death (Figure) and VT/VF (p<0.001), irrespective of treatment or LBBB. After adjustment for relevant clinical covariates including LVEF, better contractile function at baseline was associated with significantly lower risk of VT/VF/Death (HR=0.63, 95 %CI: 0.46-0.87, p=0.004) and VT/VF (HR=0.63, 95% CI: 0.44-0.91, p=0.01). Patients with improvement in GLS at 12-months had significantly lower incidence of VT/VF/Death (p<0.001) and VT/VF (p=0.008) in a landmark analysis. Every 10-percent improvement in GLS was associated with 5% decrease in the risk of VT/VF/Death (p=0.04) and 5% decrease in VT/VF (p=0.06). Both improvement in GLS and achieved GLS at 12-months were highly predictive of subsequent arrhythmic end points (Strain at 12-months Q1, VT/VF/Death: HR=0.53, 95% CI: 0.31-0.91, p=0.02; VT/VF: HR=0.54, 95% CI: 0.31-0.94, p=0.03). GLS at baseline and at 12-months demonstrated superior prediction of ventricular arrhythmias compared with LVEF in the multivariate model.

Conclusions: GLS at baseline and after 12-months was highly predictive of subsequent VT/VF/Death and VT/VF, independently of LVEF in ICD and CRT-D patients. These data suggest that strain imaging may offer greater discriminatory and predictive value than standard measures of systolic function in patients with heart failure.