Added value of echocardiographic strain indices to coronary artery disease for sudden cardiac arrest in patients with preserved ejection fraction

Abstract Background Sudden cardiac arrest (SCA) in patients with preserved left ventricular ejection fraction (LVEF ≥50%) without overt left ventricular hypertrophy is challenging for prevention. While coronary artery disease (CAD) is a known risk factor, echocardiographic parameters such as global longitudinal strain (GLS) and mechanical dispersion (MD) could contribute to risk stratification. Purpose We sought to evaluate GLS and MD for SCA risk stratification in patients with preserved LVEF, and to assess how these echocardiographic markers interact with the presence of CAD. Methods Echocardiograms of patients who were evaluated in the electrophysiology clinic were reviewed consecutively from 2017 to 2022. Among 600 patients who met the study inclusion criteria, we defined patients who suffered from SCA during follow up and compared them with age- and sex-matched subjects from the study cohort in 1:2 ratio. Left ventricular GLS was obtained from 16 segments by using speckle-tracking strain and MD was computed as the standard deviation of time-to-peak strain of 16 segments. CAD was defined >50% stenosis in any proximal or mid coronary artery. SCA events were noted over 5 years. Results Youden cut-offs were defined as -14.1% for GLS and 75.4ms for MD as indicators SCA risk. Figure 1 presents the distribution of CAD, poor GLS (>-14.1%)and prolonged MD (