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

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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.

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Acknowledgments

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Conflict of interest

Dr. Philippe Debonnaire is supported by a Sadra Medical Research Grant (Boston Scientific) and holds a European Association of Cardiovascular Imaging (EACVI) Research Grant for 2013. Dr. Darryl Leong is supported by the National Health and Medical Research Council and the National Heart Foundation of Australia. Dr. Emer Joyce holds a European Society of Cardiology Clinical Training Grant. Dr. Spyridon Katsanos is supported by the Hellenic Society of Cardiology. Dr. Victoria Delgado received consulting fees from St. Jude Medical and Medtronic. The Department of Cardiology of Leiden University Medical Centre received research grants from Biotronik, Medtronic, Boston Scientific, Lantheus Medical Imaging, Edwards Lifesciences, St. Jude Medical, GE Healthcare. No specific financial support for this work is involved.

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Authors and Affiliations

  1. Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Philippe Debonnaire, Joep Thijssen, Darryl P. Leong, Emer Joyce, Spyridon Katsanos, Georgette E. Hoogslag, Martin J. Schalij, Douwe E. Atsma, Jeroen J. Bax, Victoria Delgado & Nina Ajmone Marsan

  2. Department of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium

    Philippe Debonnaire

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  1. Philippe Debonnaire
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Correspondence to Philippe Debonnaire.

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Debonnaire, P., Thijssen, J., Leong, D.P. et al. Global longitudinal strain and left atrial volume index improve prediction of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy patients. Int J Cardiovasc Imaging 30, 549–558 (2014). https://doi.org/10.1007/s10554-014-0378-z

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