Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy

Bertini, Matteo, Ng, Arnold C. T., Borleffs, C. Jan Willem, Delgado, Victoria, Wijnmaalen, Adrianus P., Nucifora, Gaetano, Ewe, See H., Shanks, Miriam, Thijssen, Joep, Zeppenfeld, Katja, Biffi, Mauro, Leung, Dominic Y., Schalij, Martin J. and Bax, Jeroen J. (2010) Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy. American Heart Journal, 160 4: 729-736. doi:10.1016/j.ahj.2010.06.041


Author Bertini, Matteo
Ng, Arnold C. T.
Borleffs, C. Jan Willem
Delgado, Victoria
Wijnmaalen, Adrianus P.
Nucifora, Gaetano
Ewe, See H.
Shanks, Miriam
Thijssen, Joep
Zeppenfeld, Katja
Biffi, Mauro
Leung, Dominic Y.
Schalij, Martin J.
Bax, Jeroen J.
Title Longitudinal mechanics of the periinfarct zone and ventricular tachycardia inducibility in patients with chronic ischemic cardiomyopathy
Journal name American Heart Journal   Check publisher's open access policy
ISSN 0002-8703
1097-6744
Publication date 2010-10
Year available 2010
Sub-type Article (original research)
DOI 10.1016/j.ahj.2010.06.041
Volume 160
Issue 4
Start page 729
End page 736
Total pages 8
Place of publication Philadelphia, PA United States
Publisher Mosby
Collection year 2011
Language eng
Formatted abstract
Background: Quantification of segmental left ventricular (LV) strain by speckle-tracking echocardiography can identify transmural infarcts in patients with chronic ischemic cardiomyopathy. The aim of the study was to explore the relationship between the LV longitudinal peak systolic strain (LPSS) of the infarct, periinfarct, and remote zones and monomorphic ventricular tachycardia (VT) inducibility on electrophysiologic (EP) study.

Methods: A total of 134 patients with chronic ischemic cardiomyopathy scheduled for EP study were included. The protocol consisted of clinical, electrocardiographic, and echocardiographic evaluation, including LV longitudinal strain analysis using speckle-tracking echocardiography, immediately before EP study. An infarct segment was defined as a longitudinal strain value of greater than -5%, and a periinfarct segment was defined as immediately adjacent to an infarct segment.

Results:
The infarct zone had the most impaired longitudinal strain (-0.5% ± 3.0%), whereas the periinfarct and remote zones had more preserved longitudinal strain (-10.8% ± 1.9% and -14.5% ± 3.0%, respectively; analysis of variance, P < .001). Seventy-two (54%) patients had inducible monomorphic VT on EP study. There was no significant difference in LV ejection fraction (31% ± 9% vs 32% ± 11%, P = .29) between inducible and noninducible patients. Longitudinal peak systolic strain of the periinfarct zone was more impaired in inducible patients (-9.8% ± 1.5% vs -11.0% ± 2.1%, P = .001), but no differences in LPSS of the infarct (-0.5% ± 3.2% vs -0.4% ± 2.7%, P = .75) and remote (-14.6% ± 2.8% vs -14.5% ± 3.4%, P = .92) zones were observed. Only LPSS of the periinfarct zone (OR 1.43, 95% CI 1.15-1.78, P = .001) was independently related to monomorphic VT inducibility on multiple logistic regression.

Conclusions: Longitudinal strain analysis may be a useful imaging tool to risk stratify ischemic patients for malignant ventricular arrhythmia
Keyword Infarct Tissue Heterogeneity
Coronary Artery Disease
Sudden Cardiac Death
Border Zone
Postmyocardial Infarction
Myocardial-Infarction
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Tue, 30 Apr 2013, 11:14:23 EST by Dr Chin Tse Arnold Ng on behalf of School of Medicine