Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy)

Tor Biering-Sørensen; Dorit Knappe; Anne-Catherine Pouleur; Brian Claggett; Paul J Wang; Arthur J Moss; Scott D Solomon; Valentina Kutyifa

doi:10.1161/CIRCIMAGING.116.005096

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy)

Tor Biering-Sørensen, Dorit Knappe, Anne-Catherine Pouleur, Brian Claggett, Paul J Wang, Arthur J Moss, Scott D Solomon, Valentina Kutyifa

Department of Cardiology

46 Citations (Scopus)

Abstract

BACKGROUND: Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics.

METHODS AND RESULTS: We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P<0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, -7.7% versus -8.8%; P<0.001; lateral-strain, -7.3% versus -7.9%; P=0.022; inferior-strain, -8.3% versus -9.9%; P<0.001; septal-strain, -9.1% versus -10.0%; P<0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03-1.13]; P=0.001; inferior: hazard ratio, 1.08 [1.04-1.12]; P<0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00-1.11]; P=0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P=0.005).

CONCLUSIONS: Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.

Original language	English
Journal	Circulation: Cardiovascular Imaging
Volume	10
Issue number	1
ISSN	1941-9651
DOIs	https://doi.org/10.1161/CIRCIMAGING.116.005096
Publication status	Published - Jan 2017

Keywords

Aged
Biomechanical Phenomena
Cardiac Resynchronization Therapy
Chi-Square Distribution
Defibrillators, Implantable
Echocardiography
Electric Countershock
Female
Heart Failure
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Contraction
Patient Selection
Predictive Value of Tests
Proportional Hazards Models
Risk Assessment
Risk Factors
Stress, Mechanical
Stroke Volume
Tachycardia, Ventricular
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left
Ventricular Fibrillation
Ventricular Function, Left
Journal Article
Multicenter Study
Randomized Controlled Trial

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Biering-Sørensen, T., Knappe, D., Pouleur, A.-C., Claggett, B., Wang, P. J., Moss, A. J., Solomon, S. D., & Kutyifa, V. (2017). Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). Circulation: Cardiovascular Imaging, 10(1). https://doi.org/10.1161/CIRCIMAGING.116.005096

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). / Biering-Sørensen, Tor; Knappe, Dorit; Pouleur, Anne-Catherine et al.
In: Circulation: Cardiovascular Imaging, Vol. 10, No. 1, 01.2017.

Research output: Contribution to journal › Journal article › Research › peer-review

Biering-Sørensen, T, Knappe, D, Pouleur, A-C, Claggett, B, Wang, PJ, Moss, AJ, Solomon, SD & Kutyifa, V 2017, 'Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy)', Circulation: Cardiovascular Imaging, vol. 10, no. 1. https://doi.org/10.1161/CIRCIMAGING.116.005096

Biering-Sørensen T, Knappe D, Pouleur AC, Claggett B, Wang PJ, Moss AJ et al. Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). Circulation: Cardiovascular Imaging. 2017 Jan;10(1). doi: 10.1161/CIRCIMAGING.116.005096

Biering-Sørensen, Tor ; Knappe, Dorit ; Pouleur, Anne-Catherine et al. / Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction : A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). In: Circulation: Cardiovascular Imaging. 2017 ; Vol. 10, No. 1.

@article{24768f82437048cdb0bde50dbc5052ed,

title = "Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy)",

abstract = "BACKGROUND: Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics.METHODS AND RESULTS: We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24\%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3\% versus 29.5\%; P<0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, -7.7\% versus -8.8\%; P<0.001; lateral-strain, -7.3\% versus -7.9\%; P=0.022; inferior-strain, -8.3\% versus -9.9\%; P<0.001; septal-strain, -9.1\% versus -10.0\%; P<0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03-1.13]; P=0.001; inferior: hazard ratio, 1.08 [1.04-1.12]; P<0.001; per 1\% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00-1.11]; P=0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P=0.005).CONCLUSIONS: Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.",

keywords = "Aged, Biomechanical Phenomena, Cardiac Resynchronization Therapy, Chi-Square Distribution, Defibrillators, Implantable, Echocardiography, Electric Countershock, Female, Heart Failure, Humans, Male, Middle Aged, Multivariate Analysis, Myocardial Contraction, Patient Selection, Predictive Value of Tests, Proportional Hazards Models, Risk Assessment, Risk Factors, Stress, Mechanical, Stroke Volume, Tachycardia, Ventricular, Time Factors, Treatment Outcome, Ventricular Dysfunction, Left, Ventricular Fibrillation, Ventricular Function, Left, Journal Article, Multicenter Study, Randomized Controlled Trial",

author = "Tor Biering-S{\o}rensen and Dorit Knappe and Anne-Catherine Pouleur and Brian Claggett and Wang, \{Paul J\} and Moss, \{Arthur J\} and Solomon, \{Scott D\} and Valentina Kutyifa",

note = "{\textcopyright} 2016 American Heart Association, Inc.",

year = "2017",

month = jan,

doi = "10.1161/CIRCIMAGING.116.005096",

language = "English",

volume = "10",

journal = "Circulation: Cardiovascular Imaging",

issn = "1941-9651",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction

T2 - A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy)

AU - Biering-Sørensen, Tor

AU - Knappe, Dorit

AU - Pouleur, Anne-Catherine

AU - Claggett, Brian

AU - Wang, Paul J

AU - Moss, Arthur J

AU - Solomon, Scott D

AU - Kutyifa, Valentina

PY - 2017/1

Y1 - 2017/1

N2 - BACKGROUND: Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics.METHODS AND RESULTS: We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P<0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, -7.7% versus -8.8%; P<0.001; lateral-strain, -7.3% versus -7.9%; P=0.022; inferior-strain, -8.3% versus -9.9%; P<0.001; septal-strain, -9.1% versus -10.0%; P<0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03-1.13]; P=0.001; inferior: hazard ratio, 1.08 [1.04-1.12]; P<0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00-1.11]; P=0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P=0.005).CONCLUSIONS: Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.

AB - BACKGROUND: Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics.METHODS AND RESULTS: We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P<0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, -7.7% versus -8.8%; P<0.001; lateral-strain, -7.3% versus -7.9%; P=0.022; inferior-strain, -8.3% versus -9.9%; P<0.001; septal-strain, -9.1% versus -10.0%; P<0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03-1.13]; P=0.001; inferior: hazard ratio, 1.08 [1.04-1.12]; P<0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00-1.11]; P=0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P=0.005).CONCLUSIONS: Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.

KW - Aged

KW - Biomechanical Phenomena

KW - Cardiac Resynchronization Therapy

KW - Chi-Square Distribution

KW - Defibrillators, Implantable

KW - Echocardiography

KW - Electric Countershock

KW - Female

KW - Heart Failure

KW - Humans

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Contraction

KW - Patient Selection

KW - Predictive Value of Tests

KW - Proportional Hazards Models

KW - Risk Assessment

KW - Risk Factors

KW - Stress, Mechanical

KW - Stroke Volume

KW - Tachycardia, Ventricular

KW - Time Factors

KW - Treatment Outcome

KW - Ventricular Dysfunction, Left

KW - Ventricular Fibrillation

KW - Ventricular Function, Left

KW - Journal Article

KW - Multicenter Study

KW - Randomized Controlled Trial

UR - https://www.scopus.com/pages/publications/85009833799

U2 - 10.1161/CIRCIMAGING.116.005096

DO - 10.1161/CIRCIMAGING.116.005096

M3 - Journal article

C2 - 28003221

SN - 1941-9651

VL - 10

JO - Circulation: Cardiovascular Imaging

JF - Circulation: Cardiovascular Imaging

IS - 1

ER -

Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy)

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