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- Title
Left atrial booster pump function is an independent predictor of subsequent life-threatening ventricular arrhythmias in non-ischaemic cardiomyopathy.
- Authors
Kazuaki Negishi; Tomoko Negishi; Zardkoohi, Omeed; Ching, Elizabeth A.; Basu, Nivedita; Wilkoff, Bruce L.; Popovic, Zoran B.; Marwick, Thomas H.
- Abstract
Aims Left atrial (LA) function helps to preserve cardiac output and to control pulmonary capillary wedge pressure in the setting of left ventricular (LV) impairment, but little is known about the contribution of the LA function to ventricular arrhythmia. We sought whether LA booster pump function was associated with arrhythmias in patients undergoing primary prevention implantable cardioverter-defibrillator (ICD) implantation for non-ischaemic dilated cardiomyopathy (NICM), independent of global longitudinal strain (GLS) and mechanical dispersion (MD). Methods and results We identified 124 NICM patients (56 ± 13, 67 male) who underwent echocardiography pre-ICD implantation for primary prevention. The main outcome measure was appropriate ICD therapy (anti-tachycardia pacing or shock). The mitral A-wave was used as an LA functional marker. MD was defined as standard deviation of time to peak strain of each segment. Over a median follow-up of 3.8 ± 2.2 years, 36 patients had appropriate ICD therapy, including 23 shocks. Patients with appropriate ICD therapy had lower A-wave velocity (P < 0.001), larger LA volume (P < 0.001), and impaired circumferential MD (P = 0.006), but similar ejection fraction (EF) (P = 0.40) and GLS (P = 0.11). In sequential Cox proportional hazards models, A-wave, E/A ratio, and GLS were significantly associated with outcomes, independent of age, sex, and cardiac resynchronization therapy defibrillatoror left bundle branch block. In nested Cox models, mitral A-wave had a prognostic value incremental to models with LV systolic (EF and GLS) and diastolic functional parameters (E/A, E/e', and LA volume) and MD. Conclusion LA booster pump function was an independent and incremental predictor of arrhythmias in NICM over GLS and MD, and may aid better risk stratification in this population.
- Subjects
BLOOD pressure; CARDIAC pacing; DOPPLER echocardiography; IMPLANTABLE cardioverter-defibrillators; PULMONARY artery; PROPORTIONAL hazards models; DILATED cardiomyopathy; DESCRIPTIVE statistics; VENTRICULAR arrhythmia
- Publication
European Heart Journal - Cardiovascular Imaging, 2016, Vol 17, Issue 10, p1153
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jev333