title: Segmental wall-motion abnormalities of the left ventricle predict arrhythmic events in patients with nonischemic cardiomyopathy.
abstract: BACKGROUND
  Nonischemic dilated cardiomyopathy (NICM) is associated with diffuse global hypokinesia on echocardiography. However, NICM also may be associated with segmental wall-motion abnormalities (SWMAs) even in the presence of global hypokinesia, probably secondary to patchy myocardial scars.
  
  
  OBJECTIVE
  Because myocardial scars serve as substrate for reentry, the purpose of this study was to determine whether SWMA is a predictor of ventricular arrhythmic events in NICM.
  
  
  METHODS
  Echocardiographic parameters and appropriate implantable cardioverter-defibrillator (ICD) therapy for arrhythmic events (shock or antitachycardia pacing) were studied in NICM patients with an ICD. Two-dimensional echocardiography of the left ventricle was recorded in a 16-segment model. SWMA was defined by the presence of akinesia or moderate to severe hypokinesia in at least two segments. Patients were divided into one of two groups according to the presence (SWMA group) or the absence (non-SMWA group) of SWMA.
  
  
  RESULTS
  SWMA was present in 47.5% of 101 patients (mean age 58.0 ± 15.6 years, 85% male, primary prophylaxis indication 46%, mean ejection fraction 26% ± 9%, mean follow-up 29 ± 18.4 months) studied. No significant difference in mean age, ejection fraction, and QRS duration was seen between SWMA and non-SWMA groups. The SWMA group had a significantly higher incidence of arrhythmic events than did the non-SWMA group (65% vs 15%, P <.001). Kaplan-Meier survival analysis revealed that SMWA was associated with significantly reduced time to first arrhythmic event (P = .001). SWMA (P <0.001), New York Heart Association heart failure class (P = .016), and secondary prevention indication for ICD placement (P = .005) were significant independent predictors of an arrhythmic event. SWMA did not predict mortality.
  
  
  CONCLUSIONS
  SWMA is an independent predictor of arrhythmic events in patients with NICM.
authors.affiliation: Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
authors.forename: Rajdeep S
authors.initials: RS
authors.lastname: Gaitonde
authors.forename: Roopa
authors.initials: R
authors.lastname: Subbarao
authors.forename: Mark A
authors.initials: MA
authors.lastname: Michael
authors.forename: Gopi
authors.initials: G
authors.lastname: Dandamudi
authors.forename: Deepak
authors.initials: D
authors.lastname: Bhakta
authors.forename: Jo
authors.initials: J
authors.lastname: Mahenthiran
authors.forename: Mithilesh K
authors.initials: MK
authors.lastname: Das
mesh_terms: D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D013318:Stroke Volume; D016277:Ventricular Function, Left