Prognostic value of tissue Doppler imaging for predicting ventricular arrhythmias and cardiovascular mortality in ischaemic cardiomyopathy

AIMS: Only 30% of patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention receive appropriately therapy. We sought to investigate the value of tissue Doppler imaging (TDI) to predict ventricular tachycardia (VT), ventricular fibrillation (VF), and cardiovascular mortality (CVD) in patients with primary prevention ICD.

METHODS AND RESULTS: In total, 151 ICD patients meeting primary prevention criteria and with no history of ventricular arrhythmias were included. All participants were examined by conventional 2D echocardiography and TDI echocardiography. Longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured using TDI at six mitral annular sites and averaged to provide global estimates. Forty patients experienced the combined endpoint of VT, VF, or CVD during a median follow-up of 2.3 years. Left ventricular ejection fraction, global longitudinal strain, E/e', global s', and global e' were not significantly different in patients who developed VT/VF/CVD compared with those who did not. In contrast, global a' was significantly lower in patients with an unfavourable outcome compared with those without (4.8 ± 2.0 vs. 5.7 ± 1.8 cm/s, P = 0.020). Global a' remained an independent predictor of VT/VF/CVD after multivariable adjustment for age, gender, β-blocker therapy, and deceleration time (HR = 1.25 [1.02, 1.54], P = 0.032). Regional analysis revealed that a depressed a' in the inferior wall drives the predictive capability of a'.

CONCLUSION: Late diastolic velocity by TDI seems to be a superior echocardiographic predictor of VT/VF/CVD in ischaemic cardiomyopathy. Additionally, impaired late diastolic velocity in the inferior myocardial wall seems to be a paramount marker of future VT/VF/CVD.