Clinical InvestigationsEchocardiographic Assessment of Risk for Ventricular ArrhythmiasBurden of Ventricular Arrhythmias in Cardiac Resynchronization Therapy Defibrillation and Implantable Cardioverter-Defibrillator Recipients with Recovered Left Ventricular Ejection Fraction: The Additive Role of Speckle-Tracking Echocardiography
Section snippets
Population
Consecutive patients with HF with reduced ejection fraction with LVEFs ≤ 35%, QRS duration ≤ 130 msec, either ischemic or nonischemic cardiomyopathy, and New York Heart Association functional class ≥ II, for whom CRT-D device implantation was planned according to current guidelines1,2 were enrolled in this observational retrospective study. A further cohort of patients undergoing ICD therapy according to primary prevention criteria (nonischemic etiology and persistent LVEF ≤ 35% after ≥3 months
Results
From January 2008 to December 2018, 361 patients were initially screened. Of these, 40 did not met the inclusion criteria, and eight were lost to follow-up. Another 33 patients were excluded because they underwent follow-up echocardiography outside the permitted window, and 10 were excluded because of incomplete echocardiographic examinations. Therefore, the final study population consisted of 270 patients. Baseline clinical and echocardiographic characteristics of the overall study population
Discussion
In the present study, we assessed the relationships among changes in MD, improvement in LVEF at follow-up, and subsequent risk for life-threatening VAs requiring ICD intervention in patients with LV dysfunction treated with either CRT-D or ICD only. We found that (1) among candidates for primary prevention ICD, LVEF significantly improved over time, and as expected, this improvement was evident only in CRT-D patients; (2) the risk for VA occurrence during follow-up decreased in parallel with
Conclusion
Among CRT-D and ICD candidates, the risk for VAs requiring appropriate shock progressively decreased with improvement in LV function and reduction in MD. In patients whose follow-up LVEFs improved to >35%, the risk for VAs, although markedly decreased, remained high in the presence of persistently high values of MD at follow-up.
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Heart failure with improved ejection fraction: Beyond diagnosis to trajectory analysis
2024, Progress in Cardiovascular DiseasesMechanical Dispersion Is Associated With Ventricular Arrhythmias and Sudden Cardiac Death in Nonischemic Dilated Cardiomyopathy
2024, Journal of the American Society of EchocardiographyThe influence of pectus excavatum on cardiac kinetics and function in otherwise healthy individuals: A systematic review
2023, International Journal of CardiologyBeyond Ejection Fraction: Is There a Role for the Use of Mechanical Dispersion in Predicting Ventricular Arrhythmias?
2022, Journal of the American Society of Echocardiography
Conflicts of Interest: None.
This work has been funded in part by Ministero della Salute NET-016-02363853 and by Basic Research fund from the Department of Medicine, University of Perugia, D.D. 295/19.