Non Invasive Imaging

A1138JACC April 1, 2014

Volume 63, Issue 12

speckle Tracking sTrain echocardiography for risk assessMenT of venTricUlar arrhyThMias afTer lefT venTricUlar assisT device placeMenT

Poster ContributionsHall CSunday, March 30, 2014, 9:45 a.m.-10:30 a.m.

Session Title: Non Invasive Imaging: Left Ventricular Myocardial Strain Imaging-Clinical ApplicationsAbstract Category: 15. Non Invasive Imaging: EchoPresentation Number: 1174-45

Authors: Ehimare Akhabue, Chan Seok Park, Sean Pinney, Ani Anyanwu, Farooq Chaudhry, Jagat Narula, Ajith Nair, Partho Sengupta, Mount Sinai Medical Center, New York, NY, USA

Background: Patients with continuous flow left ventricular assist devices (LVAD) are at an increased risk of developing ventricular arrhythmias (VA) which can result in right ventricular dysfunction and abnormal LVAD function. We hypothesized that preoperative global left ventricular (LV) circumferential strain (CS), which correlates with transmural scar distribution, would independently predict postoperative VA following LVAD implantation.

Methods: We studied 98 consecutive patients (56±11 yrs, 83% male) who underwent HeartMate II axial flow LVAD placement. Preoperative speckle tracking derived global CS was assessed from mid-LV short axis images. The primary endpoint was defined as any ventricular tachycardia that required intervention (medication, cardioversion, implantable cardioverter-defibrillator (ICD) placement or shock) or any ventricular fibrillation.

results: A total of 31 (32%) patients experienced the primary endpoint (median follow-up: 7 months). ICD placement with history of VA (hazard ratio [HR]:2.5; 95% confidence interval [CI]:1.2 to 5.2; p = 0.009) and CS (HR: 1.2; 95% CI: 1.0-1.3; p=0.01) were significantly related to the primary endpoint. CS discriminated the occurrence of VA with a C-statistic of 0.66. An optimal cutoff value of -9.5% was associated with improved arrhythmia-free survival (Fig. 1, log-rank p =0.01).

conclusion: Preoperative global LV circumferential strain is an independent predictor of ventricular arrhythmias after LVAD placement.