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Left ventricular twist in hypertrophic cardiomyopathy

Predictor of nonsustained ventricular tachycardia

Linksventrikuläre Torsion bei hypertropher Kardiomyopathie

Prädiktor nichtanhaltender ventrikulärer Tachykardie

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Abstract

Background

We investigated the efficacy of clinical and classic echocardiographic parameters in predicting the occurrence of nonsustained ventricular tachycardia (NsVT) in patients with hypertrophic cardiomyopathy (HCM).

Methods

The study comprised 59 patients with HCM (47 male, [80%]; mean age, 48.48 ± 14.16 years). Clinical, electrocardiographic, as well as classic two-dimensional and speckle-tracking echocardiography (STE) data were collected. All patients had Holter monitoring within 24–72 h of the echocardiographic examination. NsVT was defined as three or more consecutive premature wide QRS complexes with a heart rate of > 100 bpm. The patient population was categorized into groups based on the occurrence or absence of NsVT on the 24-h Holter recordings.

Results

NsVT was observed in 17 patients (29%). In these patients, higher twist (14.4 ± 3.8 vs.18 ± 7.9; p = 0.02), higher apical rotation (8.7 ± 4.2 vs. 12.2 ± 7; p = 0.02), higher sudden cardiac death risk score (4.4 ± 2.2 vs. 7 ± 3.3; p = 0.007), and decreased global longitudinal peak strain (GLPS; −12.8 ± 3.1 vs. −10.6 ± 2.8; p = 0.014) were observed. In the multivariate logistic regression analysis, including GLPS and twist, GLPS (Odds Ratio [OR]: 1.406; 95% CI: 1.087–1.818; p = 0.009) and twist (OR: 1.236; 95% CI: 1.056–1.446; p = 0.008) were found to be independent predictors of NsVT. In the receiver operating characteristic curve analysis, GLPS < −11.9% predicted NsVT with 82% sensitivity and 60% specificity (area under the curve [AUC]: 0.70; p = 0.014) and twist > 15.2° predicted NsVT with 70% sensitivity and 58% specificity (AUC: 0.69; p = 0.027).

Conclusion

Decreased GLPS and increased twist were predictive of NsVT in HCM patients. Parameters that can easily be measured with STE can help detect patients who may develop arrhythmia.

Zusammenfassung

Hintergrund

Die Autoren untersuchten die Bedeutung klinischer und klassischer Echokardiographieparameter für die Vorhersage des Auftretens einer nichtanhaltenden ventrikulären Tachykardie (NsVT) bei Patienten mit hypertropher Kardiomyopathie (HCM).

Methoden

Die Studie umfasste 59 Patienten mit HCM (47 m., d. h. 80 %; Durchschnittsalter: 48,48 ± 14,16 Jahre). Klinische, elektrokardiographische und klassische 2‑dimensionale sowie Speckle-Tracking-Echokardiographie(STE)-Daten wurden dokumentiert. Bei allen Patienten erfolgte ein Langzeit-EKG innerhalb von 24–72 h nach der echokardiographischen Untersuchung. NsVT war definiert als 3 oder mehr aufeinanderfolgende vorzeitige breite QRS-Komplexe mit einer Herzfrequenz von > 100/min. Die Patientenpopulation wurde in Gruppen eingeteilt, je nach Vorliegen von NsVT im 24-h-EKG.

Ergebnisse

NsVT wurde bei 17 Patienten festgestellt (29 %). Diese Patienten wiesen eine höhere Torsion auf (14,4 ± 3,8 vs.18 ± 7,9; p = 0,02), stärkere apikale Rotation (8,7 ± 4,2 vs. 12,2 ± 7; p = 0,02), einen höheren Risikowert für plötzlichen Herztod (4,4 ± 2,2 vs. 7 ± 3,3; p = 0,007) und eine verminderte globale longitudinale Spitzendeformation auf (GLPS; −12,8 ± 3,1 vs. −10,6 ± 2,8; p = 0,014). In der multivariaten logistischen Regressionsanalyse, einschließlich GLPS und Torsion, stellten sich GLPS (Odds Ratio, OR: 1,406; 95 %-KI: 1,087–1,818; p = 0,009) und Torsion (OR: 1,236; 95 %-KI: 1,056–1,446; p = 0,008) als unabhängige Prädiktoren einer NsVT heraus. In der Receiver-Operating-Characteristic(ROC)-Analyse ließ sich durch eine GLPS < −11,9 % eine NsVT mit 82 % Sensitivität und 60 % Spezifität (Fläche unter der Kurve, AUC: 0,70; p = 0,014) und durch eine Torsion > 15,2° eine NsVT mit 70 % Sensitivität und 58 % Spezifität (AUC: 0,69; p = 0,027) vorhersagen.

Schlussfolgerung

Eine verminderte GLPS und erhöhte Torsion waren Prädiktoren einer NsVT bei HCM-Patienten. Somit können einfach mit der STE zu bestimmende Parameter dazu beitragen, Patienten zu erkennen, bei denen sich möglicherweise eine Arrhythmie entwickelt.

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Authors and Affiliations

  1. Cardiology Clinic, Kartal Kosuyolu Heart Training and Research Hospital, 34846, Kartal, İstanbul, Turkey

    O. Candan MD, C. Gecmen MD, A. Kalaycı MD, E. Bayam MD, A. Guner MD, S. Gunduz MD, S. Cersit MD &  M. Ozkan MD

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  1. O. Candan MD
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  2. C. Gecmen MD
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O. Candan, C. Gecmen, A. Kalaycı, E. Bayam, A. Guner, S. Gunduz, S. Cersit, and M. Ozkan declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Candan, O., Gecmen, C., Kalaycı, A. et al. Left ventricular twist in hypertrophic cardiomyopathy. Herz 44, 238–246 (2019). https://doi.org/10.1007/s00059-017-4633-7

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