Page 160 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Chapter eight. LV mechanical dispersion versus LV scar burden
Table 3. Findings at echocardiography and contrast enhanced magnetic resonance imaging.
Variable
Total population (n=96)
Echocardiography
Heart rate (bpm)
BSA ( m2)
Left ventricular end-systolic volume (ml) Left ventricular end-diastolic volume (ml) Left ventricular ejection fraction (%)
Left ventricular global longitudinal strain (%) Left ventricular mechanical dispersion (ms) Index infarction to echocardiography (days)
LGE-CMR
Left ventricular end-diastolic volume (ml)
Left ventricular mass (kg/m2)
Total percentage of Left ventricular scar tissue (%) Percentage of Left ventricular infarct core (%) Percentage of Left ventricular border zone (%) Index infarction to LGE-CMR (days)
64 ± 13 2.0 ± 0.2 56 (43-78)
117 ± 34
49 ± 10 -14.5 ± 3.8 53.5 (43.4-62.8) 104 (92-181)
137 ± 44
159 ± 42 11.4 (3.8-17.1) 6.2 (2.0-12.7) 3.5 (1.5-5.7) 74 (51-132)
Data are presented as mean ± standard deviation, number (percentage) or as median (25th- 75th percentile). BSA = angiotensin converting enzyme; BSA=body surface area, late gadolinium contrast enhanced cardiac magnetic resonance (LGE-CMR)
Follow-up and events
A total of 11 patients (12%) died and 3 (3%) patients experienced appropriate ICD therapy during a median follow-up of 6.8 (IQR 6.0-8.3) years. Kaplan-Meier curves for the combined endpoint are shown in Figure 4, with the population divided into two groups according the median LV MD (≤53.5 ms vs. >53.5 ms). The cumulative survival rates were significantly higher for patients with LV MD (>53.5 ms) as compared to patients with LV MD (≤53.5 ms) (log-rank p<0.001). On ROC curve analysis, LV MD provided the highest AUC for predicting the combined endpoint (AUC=0.847, p<0.001), followed by LV GLS (AUC = 0.822, p<0.001), total scar burden (AUC=0.768, p=0.002), infarct core (AUC=0.763, p=0.003) and border zone (AUC=0.687, p=0.032) (Figure 5, Table 4). In contrast, LVEF showed poor discrimination to identify the patients who will present with an event. In a bi-variable model, the AUC for LV MD was significantly different from that of LVEF (p<0.001). However, there were no significant differences in the AUC for LV GLS, total scar score, infarct core and border zone when compared to LV MD (p>0.05, for all) (Table 4).
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