Abstract 16694: Left Ventricular Global Longitudinal Strain Predicts Ventricular Arrhythmias in Patients with Implanted Cardiac Devices

Introduction: Abnormal left ventricular ejection fraction (LVEF) is the traditional parameter used to assess the risk of sudden cardiac death (SCD), but most SCD events occur in patients with LVEF >40%. Hypothesis: We hypothesized that global longitudinal strain (GLS) can predict SCD in patients with heart failure and implantable cardiac devices. Methods: This was a retrospective cohort study. Device interrogation and chart review was done for demographic, clinical and echocardiographic characteristics and assessment of outcomes; ventricular tachycardia (VT) or ventricular fibrillation (VF), all-cause mortality, cardiac hospitalizations, non-sustained VT and new atrial fibrillation (AF). Cox-regression analysis was performed for the association between GLS, other clinical and echocardiographic parameters and outcomes. Results: A total of 180 patients were included with males 176 (98%), HFrEF (LVEF<40%) 58 (33%), HFmEF (LVEF 40-50%) 37 (21%), HFpEF 83 (46%), ischemic cardiomyopathy 78 (43%) and non-ischemic cardiomyopathy 39 (22%). Over a median follow up of 31 months, 29 (16%) developed sustained VT/VF, 33 (18%) died, 55 (31%) had cardiac hospitalization, 74 (41%) had non-sustained VT and 25 (14%) developed new AF. Abnormal GLS (≥-17%) predicted VT/VF (HR=4.0, 95% CI 1.2 - 13.3, p=0.02) and mortality (HR=4.2, 95% CI 1.5 - 11.9, p=0.008) in the entire population. Notably, in the HFpEF group, abnormal GLS was the only predictor of mortality (HR=3.5, 95% CI 1.1 - 10.8, p=0.02; Figure 1). Conclusions: Abnormal GLS is a predictor of ventricular arrhythmias and mortality in patients with heart failure. In patients with HFpEF, GLS may be used for risk stratification upon further validation in larger studies.