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Left atrial booster pump function is an independent predictor of subsequent life-threatening ventricular arrhythmias in non-ischaemic cardiomyopathy

Citation

Negishi, K and Negishi, T and Zardkoohi, O and Ching, EA and Basu, N and Wilkoff, BL and Popovic, ZB and Marwick, TH, Left atrial booster pump function is an independent predictor of subsequent life-threatening ventricular arrhythmias in non-ischaemic cardiomyopathy, European Heart Journal Cardiovascular Imaging, 17 pp. 1153-1160. ISSN 2047-2412 (2016) [Refereed Article]

Copyright Statement

Copyright 2015 The Authors

DOI: doi:10.1093/ehjci/jev333

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 (5613, 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 3.82.2 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 defibrillator or 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.

Item Details

Item Type:Refereed Article
Keywords:implantable cardioverter-defibrillator, left atrial function, non-ischaemic cardiomyopathy, primary prevention, strain
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Negishi, K (Dr Kazuaki Negishi)
Author:Negishi, T (Dr Tomoko Negishi)
Author:Marwick, TH (Professor Tom Marwick)
ID Code:105518
Year Published:2016 (online first 2015)
Web of Science® Times Cited:4
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-01-06
Last Modified:2017-11-02
Downloads:0

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