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

Phillippe Debonnaire, Joep Thijssen, Darryl Leong, Emer Joyce, Spyridon Katsanos, Georgette Hoogslag, Martin Schalij, Douwe Atsma, Jeroen Bax, Victoria Delgado, Nina Marsan

    Research output: Contribution to journalArticlepeer-review

    35 Citations (Scopus)

    Abstract

    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 (2.2-8.2) 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 ≥1 conventional sudden cardiac death (SCD) risk factor(s) [area under the curve 0.76 (95 % CI 0.65-0.87) and 0.65 (95 % CI 0.54-0.77) versus 0.52 (95 % CI 0.43-0.58) respectively, p < 0.001]. No patient with both LAVI <34 mL/m2 and GLS <-14 % 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.

    Original languageEnglish
    Pages (from-to)549-558
    Number of pages10
    JournalInternational Journal of Cardiovascular Imaging
    Volume30
    Issue number3
    DOIs
    Publication statusPublished - Mar 2014

    Keywords

    • Global longitudinal strain
    • Hypertrophic cardiomyopathy
    • ICD therapy
    • Left atrial volume index
    • SCD risk factor

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