Strain Analysis in Patients with Frequent Premature Ventricular Complexes and Preserved Left Ventricular Function Undergoing Ablation

Abstract

Background: Frequent premature ventricular complexes (PVCs) can cause PVC-induced cardiomyopathy. The value of PVC ablation in patients with preserved left ventricular function in the low–normal range (ejection fraction: 50–55%) is not established. Strain analysis has been used to estimate changes in left ventricular function beyond assessment of the ejection fraction (EF). Longitudinal strain has been proposed as a method to detect changes over time in the setting of frequent asymptomatic premature ventricular complexes and preserved left ventricular (LV) function. A decrease in strain may be evidence of PVC-induced cardiomyopathy. Objective: In this study, we assessed the role of PVC ablation in patients with low–normal EF and the effect on EF and myocardial strain before and after PVC ablation. Methods: A total of 70 consecutive patients with either low–normal EF (0.5–<0.55, n = 35) or high–normal EF (≥0.55; n = 35), using available imaging and Holter data, were referred for ablation due to frequent PVCs. EF and longitudinal strain were assessed pre- and post-ablation. Results: There was a significant increase in EF (53.2 ± 0.4% to 58.3 ± 0.5%, p < 0.001) and improvement in longitudinal strain (−15.2 ± 3.3 to −16.6 ± 3, p = 0.007) post-ablation in patients with low–normal EF and successful ablation. There was no change in EF or longitudinal strain in patients with high–normal EF and a successful ablation pre- vs. post-ablation. Conclusions: Patients with frequent PVCs and low–normal LV EF compared to patients with frequent PVCs and high–normal LV EF have evidence of PVC-induced cardiomyopathy and may benefit from ablation despite a preserved left ventricular EF.