Global longitudinal strain and left atrial volume index improve prediction of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy patients

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• 作者：Philippe Debonnaire (1) (2)
  Joep Thijssen (1)
  Darryl P. Leong (1)
  Emer Joyce (1)
  Spyridon Katsanos (1)
  Georgette E. Hoogslag (1)
  Martin J. Schalij (1)
  Douwe E. Atsma (1)
  Jeroen J. Bax (1)
  Victoria Delgado (1)
  Nina Ajmone Marsan (1)
  
• 关键词：Hypertrophic cardiomyopathy ; ICD therapy ; Global longitudinal strain ; Left atrial volume index ; SCD risk factor
• 刊名：The International Journal of Cardiovascular Imaging (formerly Cardiac Imaging)
• 出版年：2014
• 出版时间：March 2014
• 年：2014
• 卷：30
• 期：3
• 页码：549-558
• 全文大小：687 KB
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• 作者单位：Philippe Debonnaire (1) (2)
  Joep Thijssen (1)
  Darryl P. Leong (1)
  Emer Joyce (1)
  Spyridon Katsanos (1)
  Georgette E. Hoogslag (1)
  Martin J. Schalij (1)
  Douwe E. Atsma (1)
  Jeroen J. Bax (1)
  Victoria Delgado (1)
  Nina Ajmone Marsan (1)
  
  1. Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
  2. Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
  
• ISSN：1573-0743

文摘

Accurate predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in hypertrophic cardiomyopathy (HCM) patients are lacking. Both left atrial volume index (LAVI) and global longitudinal strain (GLS) have been proposed as prognostic markers in HCM patients. The specific value of LAVI and GLS to predict appropriate ICD therapy in high-risk HCM patients was studied. LAVI and 2-dimensional speckle tracking-derived GLS were assessed in 92 HCM patients undergoing ICD implantation (69?% men, mean age 50?±?14?years). During long-term follow-up, appropriate ICD therapies, defined as antitachycardia pacing and/or shock for ventricular arrhythmia, were recorded. Appropriate ICD therapy occurred in 21 patients (23?%) during a median follow-up of 4.7 (2.2-.2) years. Multivariate analysis revealed LAVI (p?=?0.03) and GLS (p?=?0.04) to be independent predictors of appropriate ICD therapy. Both LAVI and GLS showed higher accuracy to predict appropriate ICD therapy compared to presence of ? conventional sudden cardiac death (SCD) risk factor(s) [area under the curve 0.76 (95?% CI 0.65-.87) and 0.65 (95?% CI 0.54-.77) versus 0.52 (95?% CI 0.43-.58) respectively, p?<?0.001]. No patient with both LAVI <34?mL/m2 and GLS <?4?% experienced appropriate ICD therapy. Assessment of both LAVI and GLS on top of conventional SCD risk factors provided incremental clinical predictive value for appropriate ICD therapy, as shown by likelihood ratio test (p?<?0.001) and integrated discrimination improvement index (0.17, p?<?0.001). LAVI and GLS provide high negative predictive value for appropriate ICD therapy in high-risk HCM patients. Additionally to conventional SCD risk factors, both parameters may be useful to optimize criteria and timing for ICD implantation in these patients.