Nikoo Mohammad Hossein, Zarrabi Mohammad, Moaref Alireza, Razeghian-Jahromi Iman
Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Cardiol Res Pract. 2024 Jan 16;2024:2214072. doi: 10.1155/2024/2214072. eCollection 2024.
Hypertrophic cardiomyopathy (HCM) significantly contributes to an elevated risk of sudden cardiac death. Primary prevention is implemented by using an implantable cardioverter defibrillator (ICD). However, all of the HCM patients do not really need ICD therapy. Providing a superior index for ICD indication compared with the current indices like ejection fraction is essential to differentiate high-risk patients efficiently. The present study assessed the potential of global longitudinal strain (GLS) for the differentiation of HCM patients based on their need for ICD shocks. Patients with HCM were considered in four defined centers between March and June 2021. Those with previous ICD implantation or current candidates for ICD therapy were included in the study. Participants were subjected to speckle-tracking echocardiography, and GLS as well as some other echocardiographic parameters were recorded. Afterwards, data from implanted ICDs were extracted. Patients who received ICD shocks (appropriate) due to ventricular tachycardia (VT)/ventricular fibrillation (VF) were categorized in group A. The remaining patients were constituted group B who received inappropriate shocks, i.e., other than VT/VF. Overall, 34 patients were found eligible to participate with a mean age of 62 ± 16.1 years including 64.7% of males. Among a variety of echocardiographic parameters, GLS was the sole one that was significantly higher in group A compared with that in group B. Our findings revealed that only GLS could predict fatal arrhythmias. To substantiate, the odds of VT were raised by 43% with a single increase in GLS unit. GLS showed the highest accuracy for ICD indication among HCM patients and, therefore, could be a solid and early criterion to predict the incidence of life-threatening arrhythmias. In this regard, identifying appropriate HCM patients with respect to their need for ICD therapy is feasible.
肥厚型心肌病（HCM）显著增加了心源性猝死的风险。通过植入式心律转复除颤器（ICD）进行一级预防。然而，并非所有HCM患者都真正需要ICD治疗。提供一个比当前诸如射血分数等指标更优的ICD植入指征指标对于有效区分高危患者至关重要。本研究评估了整体纵向应变（GLS）在根据HCM患者对ICD电击的需求进行区分方面的潜力。2021年3月至6月期间，在四个指定中心纳入了HCM患者。纳入研究的患者包括既往已植入ICD或目前为ICD治疗候选者。对参与者进行斑点追踪超声心动图检查，并记录GLS以及其他一些超声心动图参数。之后，提取植入ICD的数据。因室性心动过速（VT）/室颤（VF）接受ICD电击（恰当电击）的患者归为A组。其余患者构成B组，他们接受的是不恰当电击，即除VT/VF以外的情况。总体而言，34例患者符合参与条件，平均年龄为62±16.1岁，其中男性占64.7%。在各种超声心动图参数中，GLS是A组显著高于B组的唯一参数。我们的研究结果表明，只有GLS能够预测致命性心律失常。具体而言，GLS每增加一个单位，VT发生的几率提高43%。在HCM患者中，GLS对ICD植入指征显示出最高的准确性，因此，它可能是预测危及生命心律失常发生率的一个可靠且早期的标准。在这方面，根据ICD治疗需求识别合适的HCM患者是可行的。
