P824Relationship between myocardial strain and ventricular tachyarrhythmia in patients with hypertrophic cardiomyopathy


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Abstract

Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in the youth. Evaluation of SCD risk in HCM is commonly done taking into account conventional risk factors (family history, syncope, severe hypertrophy, blood pressure response to exercise and non-sustained ventricular tachycardia (NSVT)). Nowadays assignment of risk level in HCM is commonly ambiguous and implantable cardioverter-defibrillator (ICD) decision making, specially in patients with only one risk factor, should take into account other considerations. In a previous study reduced longitudinal strain (long S) estimated with speckle tracking technique was correlated with myocardial fibrosis and associated with the presence of NSVT in holter.Objective: to identify whether reduced long S is associated with VT on ICD or holter.Methods: A total of 51 consecutive HCM patients and 15 controls were included, 45% of patients had ICD implanted. We recorded images of the 4, 3 and 2-chamber apical views and short axis views. For the assessment of longitudinal (long S) and radial strain (rad S) curves, we analyzed 16 individual segments. We reviewed interrogations of ICD and registered appropiate shocks or burst due to VT and the presence of NSVT on holter.Results: During the follow-up period (mean 16.5±5.4 months), 18 patients experienced at least one episode of VT registered either on Holter or on ICD, giving an incidence rate of 35.2 %. The number of ICD therapies was 5 (9.8%). Long S and septal thickness were both independent predictors of any kind of VT (see table below).Conclusion: In the present HCM cohort decreased long S is related with an increased risk of arrythmias. Long S could be regarded as a new risk factor specially when the decision based on convencional markers is ambiguous, and its presence might tip the balance in favour of a more aggressive management.

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