Longitudinal Strain to Predict Recovery in Tachycardia-Mediated Cardiomyopathy

Study Questions:

Does left ventricular (LV) segmental longitudinal strain (LS) predict recovery of LV ejection fraction (LVEF) among patients with tachyarrhythmia and reduced LVEF?

Methods:

LV segmental LS was evaluated by two-dimensional speckle tracking in 71 consecutive patients (65 ± 16 years, 61% men) with tachyarrhythmia and reduced 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.

Results:

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 [HR], 0.59 per 1 SD; p = 0.04) and higher RALSR (HR, 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 (HR, 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).

Conclusions:

RALSR was associated with LV systolic functional recovery among patients with tachyarrhythmia, decreased LVEF, and no other known cardiovascular disease.

Perspective:

Tachycardia-mediated cardiomyopathy is potentially reversible following effective treatment of the tachyarrhythmia. However, it is not possible to reliably predict at the time of presentation whether there will be recovery of LVEF after treatment of the tachyarrhythmia. This study, performed in a small cohort of patients, suggests that a pattern of apical LV to mid- and basal LV segmental LS might help predict recovery of LVEF.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Arrhythmias, Cardiac, Cardiomyopathies, Diagnostic Imaging, Heart Failure, Recovery of Function, Stroke Volume, Systole, Tachycardia, Treatment Outcome, Ventricular Function, Left


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