title: Prognostic value of tissue Doppler imaging for predicting ventricular arrhythmias and cardiovascular mortality in ischaemic cardiomyopathy.
abstract: OBJECTIVE
  Only 30% of patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention receive appropriately therapy. We sought to investigate the value of tissue Doppler imaging (TDI) to predict ventricular tachycardia (VT), ventricular fibrillation (VF), and cardiovascular mortality (CVD) in patients with primary prevention ICD.
  
  
  RESULTS
  In total, 151 ICD patients meeting primary prevention criteria and with no history of ventricular arrhythmias were included. All participants were examined by conventional 2D echocardiography and TDI echocardiography. Longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured using TDI at six mitral annular sites and averaged to provide global estimates. Forty patients experienced the combined endpoint of VT, VF, or CVD during a median follow-up of 2.3 years. Left ventricular ejection fraction, global longitudinal strain, E/e', global s', and global e' were not significantly different in patients who developed VT/VF/CVD compared with those who did not. In contrast, global a' was significantly lower in patients with an unfavourable outcome compared with those without (4.8 ± 2.0 vs. 5.7 ± 1.8 cm/s, P = 0.020). Global a' remained an independent predictor of VT/VF/CVD after multivariable adjustment for age, gender, β-blocker therapy, and deceleration time (HR = 1.25 [1.02, 1.54], P = 0.032). Regional analysis revealed that a depressed a' in the inferior wall drives the predictive capability of a'.
  
  
  CONCLUSIONS
  Late diastolic velocity by TDI seems to be a superior echocardiographic predictor of VT/VF/CVD in ischaemic cardiomyopathy. Additionally, impaired late diastolic velocity in the inferior myocardial wall seems to be a paramount marker of future VT/VF/CVD.
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA tor.biering@gmail.com.
authors.forename: Tor
authors.initials: T
authors.lastname: Biering-Sørensen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark.
authors.forename: Flemming Javier
authors.initials: FJ
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark.
authors.forename: Katrine
authors.initials: K
authors.lastname: Storm
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fritz-Hansen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark.
authors.forename: Niels Thue
authors.initials: NT
authors.lastname: Olsen
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Jøns
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Vinther
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark Faculty of Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Søgaard
authors.affiliation: Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, DK-2900 Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Risum
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D016208:Databases, Factual; D017147:Defibrillators, Implantable; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D016011:Normal Distribution; D011237:Predictive Value of Tests; D011322:Primary Prevention; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*
keywords: ICD; cardiovascular mortality; echocardiography; tissue Doppler imaging; ventricular arrhythmias