The risk stratification in patients with heart failure: the value of considering both global longitudinal left ventricular strain and mechanical dispersion

In previous studies mechanical dispersion (MD) predicted ventricular arrhythmias independently of left ventricular ejection fraction (LVEF). Moreover the combination of MD and global longitudinal strain (GLS) increased the prediction of arrhythmic events. We investigated the prognostic value of a new 2D-strain index, GLS/MD, in patients with heart failure (HF). We analysed 340 consecutive HF outpatients in sinus rhythm. Echocardiography was performed at 1.6±0.4 months after hospital discharge. The end point included sudden cardiac death, ventricular fibrillation and sustained ventricular tachycardia (SCD/VA). During the follow-up period (36±9 months) SCD/VA occurred in 48 patients (14.1%). By using the multivariate Cox regression analysis, including LVEF, early diastolic transmitral/mitral annular velocity ratio (E/E’), GLS, MD and GLS/MD in the model, GLS/MD was the best independent predictor of SCD/VA (HR=3.22, 95% confidence interval =1.72-6.15, p=0.03). Separate inclusion of LVEF, systolic mitral annu...