Clinical Utility of Longitudinal Strain to Predict Functional Recovery in Patients With Tachyarrhythmia and Reduced LVEF.
This study sought to assess the time course of presumptive tachycardia-induced cardiomyopathy and the predictors of left ventricular (LV) functional recovery in such patients.



Tachycardia-induced cardiomyopathy is a potentially reversible cardiomyopathy with effective treatment of the tachyarrhythmia. However, cases without improvement of LV systolic function were found occasionally. The diagnosis of tachycardia-induced cardiomyopathy can be challenging, and the role of echocardiographic imaging in the prediction of LV functional recovery is limited.



LV segmental longitudinal strains (LS) were evaluated by 2-dimensional speckle tracking in 71 consecutive patients (65 ± 16 years; 61% men) with tachyarrhythmia and reduced left ventricular ejection fraction (LVEF) without any other known cardiovascular disease, and 30 age and sex-matched control subjects. Relative apical LS ratio (RALSR) was defined using the equation: average apical LS / (average basal LS + average mid LS) as a marker of strain distribution.



Compared with control subjects, patients with tachyarrhythmia had significantly lower global LS. Improvement in LVEF within 6 months after treatment of index arrhythmia was observed in 41 patients, and LVEF did not improve in 30 patients. In univariate analysis, lower LVEF at baseline (hazard ratio: 0.59 per 1 SD; p = 0.04) and higher RALSR (hazard ratio: 11.2 per 1 SD; p < 0.001) were associated with no recovery in LVEF during follow-up. In a multivariate logistic regression model, the significant predictor of LV systolic functional recovery was RALSR (hazard ratio: 22.9 per 1 SD; p = 0.001). A RALSR of 0.61 was sensitive (71%) and specific (90%) in differentiating LV systolic functional recovery (area under the curve: 0.88).



The RALSR was associated with LV systolic functional recovery. This information might be useful for clinical evaluation and follow-up in patients with reduced LVEF.
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Kenya
K
Kusunose
Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
Yuta
Y
Torii
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan. Electronic address: yamadah@tokushima-u.ac.jp.
Hirotsugu
H
Yamada
Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
Susumu
S
Nishio
Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
Yukina
Y
Hirata
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Hiromitsu
H
Seno
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Yoshihito
Y
Saijo
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Takayuki
T
Ise
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Koji
K
Yamaguchi
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Takeshi
T
Tobiume
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Shusuke
S
Yagi
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Takeshi
T
Soeki
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Tetsuzo
T
Wakatsuki
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
Masataka
M
Sata
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001696:Biomechanical Phenomena; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D015203:Reproducibility of Results; D013314:Stress, Mechanical; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
functional recovery; strain imaging; tachycardia-induced cardiomyopathy