title: Regional Longitudinal Deformation Improves Prediction of Ventricular Tachyarrhythmias in Patients With Heart Failure With Reduced Ejection Fraction: A MADIT-CRT Substudy (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy).
abstract: BACKGROUND
  Left ventricular dysfunction is a known predictor of ventricular arrhythmias. We hypothesized that measures of regional longitudinal deformation by speckle-tracking echocardiography predict ventricular tachyarrhythmias and provide incremental prognostic information over clinical and conventional echocardiographic characteristics.
  
  
  RESULTS
  We studied 1064 patients enrolled in the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy) with speckle-tracking data available. Peak longitudinal strain was obtained for the septal, lateral, anterior, and inferior myocardial walls at baseline. The end point was the first event of ventricular tachycardia (VT) or fibrillation (VF). During the median follow-up of 2.9 years, 254 (24%) patients developed VT/VF. Patients with VT/VF had significantly lower left ventricular ejection fraction (28.3% versus 29.5%; P<0.001) and longitudinal strain in all myocardial walls compared with patients without VT/VF (anterior-strain, -7.7% versus -8.8%; P<0.001; lateral-strain, -7.3% versus -7.9%; P=0.022; inferior-strain, -8.3% versus -9.9%; P<0.001; septal-strain, -9.1% versus -10.0%; P<0.001). After multivariate adjustment, only anterior and inferior longitudinal strain remained independent predictors of VT/VF (anterior: hazard ratio, 1.08 [1.03-1.13]; P=0.001; inferior: hazard ratio, 1.08 [1.04-1.12]; P<0.001; per 1% absolute decrease for both). When including B-type natriuretic peptide in the model, only a decreasing myocardial function in the inferior myocardial wall predicted VT/VF (hazard ratio, 1.05 [1.00-1.11]; P=0.039). Only strain obtained from the inferior myocardial wall provided incremental prognostic information for VT/VF over clinical and echocardiographic parameters (C statistic 0.71 versus 0.69; P=0.005).
  
  
  CONCLUSIONS
  Assessment of regional longitudinal myocardial deformation in the inferior region provided incremental prognostic information over clinical and echocardiographic risk factors in predicting ventricular tachyarrhythmias.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.
authors.affiliation: From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.).
authors.forename: Tor
authors.initials: T
authors.lastname: Biering-Sørensen
authors.affiliation: From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.).
authors.forename: Dorit
authors.initials: D
authors.lastname: Knappe
authors.affiliation: From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.).
authors.forename: Anne-Catherine
authors.initials: AC
authors.lastname: Pouleur
authors.affiliation: From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.).
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.).
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Wang
authors.affiliation: From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.).
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.). ssolomon@rics.bwh.harvard.edu.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: From the Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., D.K., A.-C.P., B.C., S.D.S.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark (T.B.-S.); Stanford University of Medicine, Palo Alto, CA (P.J.W.); and University of Rochester Medical Center, NY (A.J.M., V.K.).
authors.forename: Valentina
authors.initials: V
authors.lastname: Kutyifa
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D058406:Cardiac Resynchronization Therapy; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D016277:Ventricular Function, Left
keywords: cardiac resynchronization therapy; defibrillators, implantable; echocardiography; heart failure; tachycardia, ventricular