OBJECTIVE

To assess the possibilities of speckle-tracking and 24-hour ECG monitoring in patients with structural heart disease and chronic heart failure (CHF) with reduced LV EF in predicting the risk of malignant ventricular tachyarrhythmias (VTA).

MATERIAL AND METHODS

The study included 60 patients with CHF class I—III with LVEF <35% under optimal drug therapy for more than 3 months. The follow-up period was 27 [21; 36] months. Univariate, ROC and multivariate analyses of groups with and without VTA were carried out with assessing speckle-tracking (mechanical dispersion (MD), global and segmental longitudinal strain (LS)) and 24-hour ECG monitoring data (ventricular ectopic activity, heart rate variability, late potentials, T-wave microalternation, duration of QRS-complex).

RESULTS

Patients with VTA (n=30) significantly differed from those without VTA (n=30) by LV MD (p<0.001) and LS of basal segment of anterior septum wall (p=0.03), basal segment of inferior septum wall (p=0.01) and middle segment of inferior LV wall (p=0.04). The optimal cut-off value of LV MD regarding VTA was ≥120 ms (AUC 0.817, sensitivity 73.3%, specificity 80%). Multifactorial analysis revealed 3 independent markers of VTA: LV MD ≥120 ms, LS of basal segment of posterior septum wall ≤–8% and standard deviation of QRS complex duration at night ≥3 ms. Two out of three these variables can predict VTA with accuracy of 77% (sensitivity 73%, specificity 80%).

CONCLUSION

Left ventricle mechanical dispersion and LS combined with standard deviation of QRS-complex duration at night were the independent risk factors of VTA in patients with CHF and reduced LVEF.