Left Ventricular Global Longitudinal Strain Is Associated With Appropriate Therapies for Ventricular Arrhythmias Independent of Left Ventricular Ejection Fraction in Patients With Primary Prevention Defibrillators.

BACKGROUND

Left ventricular ejection fraction (LVEF) has not demonstrated reliability in predicting ventricular arrhythmias or appropriate implantable cardioverter defibrillator (ICD) therapy (AICDt).

OBJECTIVE

To evaluate the association between left ventricular global longitudinal strain (GLS) and AICDt.

METHODS

One hundred seventy-eight consecutive patients who received ICD implants for primary prevention of sudden cardiac death from 1/16/2015 to 1/26/2022 were followed until 1st appropriate ICD therapy (AICDt) for a ventricular arrhythmia, death, or loss to follow-up. AICDt were physician adjudicated. Covariates included demographic variables (age, sex), clinical risk factors (LVEF, cardiac resynchronization therapy, coronary artery disease, anti-arrhythmic drug use, QRS duration), and variables from the DO-IT model (nonsustained ventricular tachycardia, atrial fibrillation, glomerular filtration rate, peripheral vascular disease, direct oral anticoagulant use, digoxin use, aldosterone antagonist use, and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker use). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI95) of GLS per 5% decrease (absolute value) for AICDt.

RESULTS

Over a mean (standard deviation) follow up period of 5.09 (2.11) years, 44 of the 178 patients (79.77% male, 63.89 (12.89) years of age) in the final cohort experienced AICDt. In patients with coronary artery disease, GLS per 5% decrease (absolute value) was associated with AICDt independent of demographic variables (HR 2.16, CI95 1.09-4.27), clinical risk factors (HR 2.54, CI95 1.16-5.59), and variables from the DO-IT model (HR 3.28, CI95 1.46-7.36).

CONCLUSION

Reduced GLS (absolute value) is an independent risk factor for AICDt in patients with coronary artery disease.