Advertisement

Global longitudinal strain and left atrial volume index improve prediction of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy patients

  • Philippe Debonnaire
  • Joep Thijssen
  • Darryl P. Leong
  • Emer Joyce
  • Spyridon Katsanos
  • Georgette E. Hoogslag
  • Martin J. Schalij
  • Douwe E. Atsma
  • Jeroen J. Bax
  • Victoria Delgado
  • Nina Ajmone Marsan
Original Paper

Abstract

Accurate predictors of appropriate implantable cardioverter defibrillator (ICD) therapy in hypertrophic cardiomyopathy (HCM) patients are lacking. Both left atrial volume index (LAVI) and global longitudinal strain (GLS) have been proposed as prognostic markers in HCM patients. The specific value of LAVI and GLS to predict appropriate ICD therapy in high-risk HCM patients was studied. LAVI and 2-dimensional speckle tracking-derived GLS were assessed in 92 HCM patients undergoing ICD implantation (69 % men, mean age 50 ± 14 years). During long-term follow-up, appropriate ICD therapies, defined as antitachycardia pacing and/or shock for ventricular arrhythmia, were recorded. Appropriate ICD therapy occurred in 21 patients (23 %) during a median follow-up of 4.7 (2.2–8.2) years. Multivariate analysis revealed LAVI (p = 0.03) and GLS (p = 0.04) to be independent predictors of appropriate ICD therapy. Both LAVI and GLS showed higher accuracy to predict appropriate ICD therapy compared to presence of ≥1 conventional sudden cardiac death (SCD) risk factor(s) [area under the curve 0.76 (95 % CI 0.65–0.87) and 0.65 (95 % CI 0.54–0.77) versus 0.52 (95 % CI 0.43–0.58) respectively, p < 0.001]. No patient with both LAVI <34 mL/m2 and GLS <−14 % experienced appropriate ICD therapy. Assessment of both LAVI and GLS on top of conventional SCD risk factors provided incremental clinical predictive value for appropriate ICD therapy, as shown by likelihood ratio test (p < 0.001) and integrated discrimination improvement index (0.17, p < 0.001). LAVI and GLS provide high negative predictive value for appropriate ICD therapy in high-risk HCM patients. Additionally to conventional SCD risk factors, both parameters may be useful to optimize criteria and timing for ICD implantation in these patients.

Keywords

Hypertrophic cardiomyopathy ICD therapy Global longitudinal strain Left atrial volume index SCD risk factor 

Notes

Acknowledgments

None.

Conflict of interest

Dr. Philippe Debonnaire is supported by a Sadra Medical Research Grant (Boston Scientific) and holds a European Association of Cardiovascular Imaging (EACVI) Research Grant for 2013. Dr. Darryl Leong is supported by the National Health and Medical Research Council and the National Heart Foundation of Australia. Dr. Emer Joyce holds a European Society of Cardiology Clinical Training Grant. Dr. Spyridon Katsanos is supported by the Hellenic Society of Cardiology. Dr. Victoria Delgado received consulting fees from St. Jude Medical and Medtronic. The Department of Cardiology of Leiden University Medical Centre received research grants from Biotronik, Medtronic, Boston Scientific, Lantheus Medical Imaging, Edwards Lifesciences, St. Jude Medical, GE Healthcare. No specific financial support for this work is involved.

References

  1. 1.
    Maron BJ, Spirito P, Shen WK et al (2007) Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA 298:405–412PubMedGoogle Scholar
  2. 2.
    Gersh BJ, Maron BJ, Bonow RO et al (2011) 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 124:e783–e831PubMedCrossRefGoogle Scholar
  3. 3.
    Schinkel AF, Vriesendorp PA, Sijbrands EJ, Jordaens LJ, ten Cate FJ, Michels M (2012) Outcome and complications after implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: systematic review and meta-analysis. Circ Heart Fail 5:552–559PubMedCrossRefGoogle Scholar
  4. 4.
    Maron BJ (2010) Contemporary insights and strategies for risk stratification and prevention of sudden death in hypertrophic cardiomyopathy. Circulation 121:445–456PubMedCrossRefGoogle Scholar
  5. 5.
    Serri K, Reant P, Lafitte M et al (2006) Global and regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy. J Am Coll Cardiol 47:1175–1181PubMedCrossRefGoogle Scholar
  6. 6.
    Kato TS, Noda A, Izawa H et al (2004) Discrimination of nonobstructive hypertrophic cardiomyopathy from hypertensive left ventricular hypertrophy on the basis of strain rate imaging by tissue Doppler ultrasonography. Circulation 110:3808–3814PubMedCrossRefGoogle Scholar
  7. 7.
    Mor-Avi V, Lang RM, Badano LP et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 24:277–313PubMedCrossRefGoogle Scholar
  8. 8.
    Maron BJ, Maron MS (2012) Hypertrophic cardiomyopathy. Lancet 381:242–255PubMedCrossRefGoogle Scholar
  9. 9.
    Paraskevaidis IA, Farmakis D, Papadopoulos C et al (2009) Two-dimensional strain analysis in patients with hypertrophic cardiomyopathy and normal systolic function: a 12-month follow-up study. Am Heart J 158:444–450PubMedCrossRefGoogle Scholar
  10. 10.
    Saito M, Okayama H, Yoshii T et al (2012) Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 13:617–623PubMedCrossRefGoogle Scholar
  11. 11.
    Losi MA, Betocchi S, Barbati G et al (2009) Prognostic significance of left atrial volume dilatation in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 22:76–81PubMedCrossRefGoogle Scholar
  12. 12.
    Tani T, Yagi T, Kitai T et al (2011) Left atrial volume predicts adverse cardiac and cerebrovascular events in patients with hypertrophic cardiomyopathy. Cardiovasc Ultrasound 9:34PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Yang H, Woo A, Monakier D et al (2005) Enlarged left atrial volume in hypertrophic cardiomyopathy: a marker for disease severity. J Am Soc Echocardiogr 18:1074–1082PubMedCrossRefGoogle Scholar
  14. 14.
    Yang WI, Shim CY, Kim YJ et al (2009) Left atrial volume index: a predictor of adverse outcome in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 22:1338–1343PubMedCrossRefGoogle Scholar
  15. 15.
    Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463PubMedCrossRefGoogle Scholar
  16. 16.
    Antoni ML, Mollema SA, Delgado V et al (2010) Prognostic importance of strain and strain rate after acute myocardial infarction. Eur Heart J 31:1640–1647PubMedCrossRefGoogle Scholar
  17. 17.
    Nagueh SF, Appleton CP, Gillebert TC et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133PubMedCrossRefGoogle Scholar
  18. 18.
    Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802PubMedCrossRefGoogle Scholar
  19. 19.
    DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845PubMedCrossRefGoogle Scholar
  20. 20.
    Pencina MJ, D’Agostino RB Sr., D’Agostino RB Jr., Vasan RS (2008) Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 27:157–172; discussion 207–112Google Scholar
  21. 21.
    O’Mahony C, Tome-Esteban M, Lambiase PD et al (2013) A validation study of the 2003 American College of Cardiology/European Society of Cardiology and 2011 American College of Cardiology Foundation/American Heart Association risk stratification and treatment algorithms for sudden cardiac death in patients with hypertrophic cardiomyopathy. Heart 99:534–541PubMedCrossRefGoogle Scholar
  22. 22.
    Bos JM, Maron BJ, Ackerman MJ et al (2010) Role of family history of sudden death in risk stratification and prevention of sudden death with implantable defibrillators in hypertrophic cardiomyopathy. Am J Cardiol 106:1481–1486PubMedCrossRefGoogle Scholar
  23. 23.
    O’Mahony C, Lambiase PD, Quarta G et al (2012) The long-term survival and the risks and benefits of implantable cardioverter defibrillators in patients with hypertrophic cardiomyopathy. Heart 98:116–125PubMedCrossRefGoogle Scholar
  24. 24.
    Prinz C, Vogt J, Bitter T et al (2010) Incidence of adequate ICD interventions in patients with hypertrophic cardiomyopathy supposed to be at high risk for sudden cardiac death. Acta Cardiol 65:521–525PubMedGoogle Scholar
  25. 25.
    Syska P, Przybylski A, Chojnowska L et al (2010) Implantable cardioverter-defibrillator in patients with hypertrophic cardiomyopathy: efficacy and complications of the therapy in long-term follow-up. J Cardiovasc Electrophysiol 21:883–889PubMedGoogle Scholar
  26. 26.
    Vriesendorp PA, Schinkel AF, Van Cleemput J et al (2013) Implantable cardioverter-defibrillators in hypertrophic cardiomyopathy: patient outcomes, rate of appropriate and inappropriate interventions, and complications. Am Heart J 166:496–502PubMedCrossRefGoogle Scholar
  27. 27.
    Woo A, Monakier D, Harris L et al (2007) Determinants of implantable defibrillator discharges in high-risk patients with hypertrophic cardiomyopathy. Heart 93:1044–1045PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Bruder O, Wagner A, Jensen CJ et al (2010) Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 56:875–887PubMedCrossRefGoogle Scholar
  29. 29.
    O’Hanlon R, Grasso A, Roughton M et al (2010) Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol 56:867–874PubMedCrossRefGoogle Scholar
  30. 30.
    Bauer F, Shiota T, White RD et al (2004) Determinant of left atrial dilation in patients with hypertrophic cardiomyopathy: a real-time 3-dimensional echocardiographic study. J Am Soc Echocardiogr 17:968–975PubMedCrossRefGoogle Scholar
  31. 31.
    Nistri S, Olivotto I, Betocchi S et al (2006) Prognostic significance of left atrial size in patients with hypertrophic cardiomyopathy (from the Italian Registry for Hypertrophic Cardiomyopathy). Am J Cardiol 98:960–965PubMedCrossRefGoogle Scholar
  32. 32.
    O’Mahony C, Jichi F, Pavlou M et al (2013) A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM Risk-SCD). Eur Heart J. doi: 10.1093/eurheartj/eht439
  33. 33.
    Tsang TS, Abhayaratna WP, Barnes ME et al (2006) Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol 47:1018–1023PubMedCrossRefGoogle Scholar
  34. 34.
    Cha YM, Gersh BJ, Maron BJ et al (2007) Electrophysiologic manifestations of ventricular tachyarrhythmias provoking appropriate defibrillator interventions in high-risk patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 18:483–487PubMedCrossRefGoogle Scholar
  35. 35.
    O’Mahony C, Lambiase PD, Rahman SM et al (2012) The relation of ventricular arrhythmia electrophysiological characteristics to cardiac phenotype and circadian patterns in hypertrophic cardiomyopathy. Europace 14:724–733PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Philippe Debonnaire
    • 1
    • 2
  • Joep Thijssen
    • 1
  • Darryl P. Leong
    • 1
  • Emer Joyce
    • 1
  • Spyridon Katsanos
    • 1
  • Georgette E. Hoogslag
    • 1
  • Martin J. Schalij
    • 1
  • Douwe E. Atsma
    • 1
  • Jeroen J. Bax
    • 1
  • Victoria Delgado
    • 1
  • Nina Ajmone Marsan
    • 1
  1. 1.Department of CardiologyLeiden University Medical CentreLeidenThe Netherlands
  2. 2.Department of CardiologySint-Jan Hospital BrugesBrugesBelgium

Personalised recommendations