Speckle-Tracking Echocardiography Parameters Associated With Ventricular Arrhythmia Recurrence–Free Survival After Ablation in Structural Heart Disease

IF 6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2025-09-01 DOI:10.1016/j.echo.2025.05.004

Siddharth J. Trivedi BSc, BMedSci (Hons), MBBS (Hons), PhD , Richard G. Bennett BSc, MBChB , Karen Byth CStatRSS, PhD , Timothy Campbell BSc , Samual Turnbull BSc , Luke Stefani BBioMedSci , Saurabh Kumar BSc (Med)/MBBS, PhD , Liza Thomas MBBS, PhD

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引用次数: 0

Abstract

Background

Catheter ablation (CA) is indicated for drug-refractory ventricular arrhythmias (VAs). Predicting adverse outcomes (recurrent VA or mortality) after CA is important, but current tools are imperfect. Speckle-tracking echocardiography quantifies global longitudinal strain (GLS), a measure of myocardial deformation, and mechanical dispersion (MD) and delta contraction duration (DCD) (measures of myocardial contraction heterogeneity). The aim of this study was to examine the associations between clinical, procedural, and echocardiographic parameters and subsequent VA recurrence or death.

Methods

One hundred eighty-one patients (ischemic cardiomyopathy, n = 82; nonischemic cardiomyopathy, n = 99) with VAs undergoing CA underwent echocardiography, including measurements of left ventricular GLS, MD, and DCD. Patients were longitudinally followed for first occurrence of VA recurrence or death; in the absence of VA recurrence or death, a patient was deemed to have VA recurrence–free survival.

Results

Median follow-up duration was 21.0 months. After the procedure, 20 patients (11%) died without any prior VA recurrence, and 77 patients (43%) experienced VA recurrence, of whom 11 subsequently died. Cox proportional-hazards regression analysis identified acute procedural failure, at least two inducible VAs, DCD, and the interaction between GLS and DCD as significant predictors of VA recurrence–free survival. When GLS and DCD were dichotomized by their median values (GLS ≤ −11.5% vs >−11.5%; DCD ≤ 190 vs >190 ms), DCD > 190 ms was a predictor of the composite endpoint irrespective of GLS status. MD was not as strong a predictor as DCD.

Conclusions

In patients undergoing CA for VAs, the only echocardiographic predictor of VA recurrence–free survival was prolonged DCD, irrespective of GLS and clinical and procedural factors. Hence, DCD may facilitate risk stratification before CA.

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斑点跟踪超声心动图参数与结构性心脏病消融后室性心律失常无复发生存相关。

背景：导管消融（CA）适用于药物难治性室性心律失常（VAs）。预测ca后的不良后果（复发性VA/死亡率）很重要；然而，目前的工具并不完美。斑点跟踪超声心动图量化了总体纵向应变（GLS），一种测量心肌变形的方法，以及机械离散度（MD）和三角洲收缩持续时间（DCD）（测量心肌收缩异质性）。目的：探讨临床、手术和超声心动图参数与VA复发或死亡之间的关系。方法：181例（缺血性（n=82），非缺血性心肌病（n=99））的VAs行CA行超声心动图包括左室GLS， MD和DCD的测量。对患者进行首次VA复发或死亡的纵向随访；在没有VA复发或死亡的情况下，患者被认为具有VA无复发生存期。结果：中位随访时间为21.0个月。手术后，20名患者（11%）死亡，之前没有任何VA复发，77名患者（43%）经历VA复发，其中11名患者随后死亡。Cox比例风险回归分析发现，急性程序性心力衰竭、≥2诱导VAs、DCD以及GLS和DCD之间的相互作用是VA无复发生存的重要预测因素。当GLS和DCD按中位数分二时，(GLS≤-11.5% vs > -11.5%；DCD≤190ms（与>190ms相比），DCD>190ms是与GLS状态无关的复合终点的预测因子。MD的预测力不如DCD强。结论：在接受静脉辅助血管置换术的患者中，超声心动图预测无复发生存的唯一指标是延长的DCD，与GLS、临床和手术因素无关。因此，DCD可能有助于在CA之前进行风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.