Background: Left ventricular ejection fraction (LVEF) remains central to ICD eligibility assessment but has limited ability to discriminate arrhythmic risk among patients with LVEF ≤40%. Global longitudinal strain (GLS), mechanical dispersion (MD), and E/e′ ratio may provide markers associated with ventricular arrhythmias.

Objectives: To compare GLS, MD, and E/e′ between patients with left ventricular systolic dysfunction with and without documented ventricular arrhythmias and assess their discriminative ability.

Methods: In this observational study, 66 patients with LVEF ≤40% were stratified into Group A (VA+, n=33) and Group B (No VA, n=33). GLS and MD were derived by two-dimensional speckle-tracking echocardiography (QLAB, Philips Affiniti 70C). Group comparisons used Student’s t-test or Mann–Whitney U test, as appropriate. ROC analysis assessed discriminative ability.

Result: GLS (−9.8 ± 2.2% vs −13.7 ± 2.1%), MD (86.1 ± 16.0 vs 63.9 ± 13.9 ms), and E/e′ (16.6 ± 4.6 vs 11.4 ± 2.1) were significantly impaired in Group A (all p < 0.001). Left atrial volume index (LAVI) was higher in Group A (39.4 ± 9.5 vs 33.6 ± 8.7 mL/m2, p=0.014). LVEF showed a modest difference (29.4 ± 4.9% vs 32.2 ± 4.2%, p=0.016), while LVIDd was comparable (p=0.127). ROC analysis showed AUCs of 0.899 (95% CI: 0.816–0.963) for GLS, 0.853 (0.752–0.938) for MD, and 0.851 (0.741–0.944) for E/e′. Sensitivity/specificity were 82%/85% for GLS, 82%/79% for MD, and 70%/97% for E/e′.

Conclusion: GLS, MD, and E/e′ differed significantly between patients with left ventricular dysfunction with and without ventricular arrhythmias, with AUCs of 0.85–0.90. These findings suggest that advanced echocardiographic parameters may provide additional discrimination of ventricular arrhythmia status beyond LVEF. Prospective validation in larger cohorts is warranted.

Mukesh Sharma is a Senior Professor and Head of the Department of Cardiology at R.N.T. Medical College, Udaipur, Rajasthan. He completed his MBBS and MD (Medicine) from S.P. Medical College, Bikaner, followed by his DM in Cardiology from Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, in 2005. He joined R.N.T. Medical College in 2006 and has progressed through the academic ranks from Assistant Professor to Senior Professor and Head of the Department. He has approximately 23 years of experience in teaching and clinical cardiology and has performed and supervised around 40,000 diagnostic and interventional cardiac procedures. As a DM Cardiology teacher, he has trained numerous postgraduate cardiologists and has served as an examiner for DM and DNB examinations. He has contributed as a cardiology expert to the Rajasthan Public Service Commission and the Medical Council of India (now NMC), and has served on various government committees related to medical education and healthcare policies. He is a Fellow of the American College of Cardiology (FACC) and the European Society of Cardiology (FESC), and is a life member of several national and international professional societies. He has delivered numerous lectures, presented at national and international conferences, and chaired scientific sessions. He has approximately 30 publications in national and international journals. He currently serves as Honorary Secretary of the Indian Society of Cardiology and Associate Editor of the Indian Journal of Cardiology, and has also served on the executive committees of the Indian Association of Echocardiography and the Rajasthan chapter of the Cardiological Society of India. Under his leadership, the Department of Cardiology at R.N.T. Medical College has significantly expanded its academic and clinical capabilities, including increasing DM Cardiology seats from 2 to 5, establishing a 20-bed cardiac ICU, and developing dedicated programs in congenital, structural, electrophysiology, and cardiac rhythm management. The department has also introduced advanced technologies including OCT, FFR, ReDS, high-end echocardiography, 3D electrophysiology systems and 2 new cath labs, further strengthening comprehensive cardiac care in southern Rajasthan.