Prediction of Ventricular Arrhythmias With Left Ventricular Mechanical Dispersion: A Systematic Review and Meta-Analysis

Hiroshi Kawakami; Nitesh Nerlekar; Kristina H Haugaa; Thor Edvardsen; Thomas H Marwick

doi:10.1016/j.jcmg.2019.03.025

Prediction of Ventricular Arrhythmias With Left Ventricular Mechanical Dispersion: A Systematic Review and Meta-Analysis

JACC Cardiovasc Imaging. 2020 Feb;13(2 Pt 2):562-572. doi: 10.1016/j.jcmg.2019.03.025. Epub 2019 Jun 12.

Authors

Hiroshi Kawakami¹, Nitesh Nerlekar¹, Kristina H Haugaa², Thor Edvardsen², Thomas H Marwick³

Affiliations

¹ Baker Heart and Diabetes Institute, Melbourne, Australia.
² Centre of Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway.
³ Baker Heart and Diabetes Institute, Melbourne, Australia. Electronic address: tom.marwick@baker.edu.au.

PMID: 31202762
DOI: 10.1016/j.jcmg.2019.03.025

Abstract

Objectives: The aim of this study was to assess the association between left ventricular mechanical dispersion (LVMD) and the incidence of ventricular arrhythmias (VAs).

Background: Recent, mainly single-center, studies have demonstrated that LVMD assessed using speckle tracking might be a powerful marker in risk stratification for VA. A systematic review and meta-analysis provides a means of understanding the prognostic value of this parameter, relative to other parameters, the most appropriate cutoff for designating risk.

Methods: A systemic review of studies reporting the predictive value of LVMD for VA was undertaken from a search of MEDLINE and Embase. VA events were defined as sudden cardiac death, cardiac arrest, documented ventricular tachyarrhythmia, and appropriate implantable cardioverter-defibrillator (ICD) therapy. Hazard ratios were extracted from univariate and multivariate models reporting on the association of LVMD and VA and described as pooled estimates with 95% confidence intervals. In a meta-analysis, the predictive value of LVMD was compared with that of left ventricular ejection fraction and global longitudinal strain.

Results: Among 3,198 patients in 12 published studies, 387 (12%) had VA events over follow-up ranging from 17 to 70 months. Patients with VAs had greater LVMD than those without (weighted mean difference -20.3 ms; 95% confidence interval: -27.3 to -13.2; p < 0.01). Each 10 ms increment of LVMD was significantly and independently associated with VA events (hazard ratio: 1.19; 95% confidence interval: 1.09 to 1.29; p < 0.01). The predictive value of LVMD was superior to that of left ventricular ejection fraction or global longitudinal strain.

Conclusions: LVMD assessed using speckle tracking provides important predictive value for VA in patients with a number of cardiac diseases and appears to have superior predictive value over left ventricular ejection fraction and global longitudinal strain for risk stratification.

Keywords: mechanical dispersion; meta-analysis; strain; ventricular arrhythmia.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Aged
Aged, 80 and over
Arrhythmias, Cardiac / diagnosis
Arrhythmias, Cardiac / mortality
Arrhythmias, Cardiac / physiopathology*
Arrhythmias, Cardiac / therapy
Echocardiography, Doppler*
Female
Heart Rate*
Humans
Incidence
Male
Middle Aged
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors
Stroke Volume
Ventricular Dysfunction, Left / diagnostic imaging*
Ventricular Dysfunction, Left / mortality
Ventricular Dysfunction, Left / physiopathology
Ventricular Dysfunction, Left / therapy
Ventricular Function, Left*