Objective: to determine the association between mechanical dispersion (MD) and the development of ventricular arrhythmias (VA) in patients with coronary artery disease (CAD) after myocardial infarction (MI) using two-dimensional speckle-tracking echocardiography (2D-STE).

Materials and Methods. The study included 80 patients with CAD and post-infarction cardiosclerosis (history of Q-wave left ventricular MI on ECG). Patients were divided into two groups: with ventricular arrhythmias (VA) (n = 58) and without VA (n = 22). The mean age was 61.6 ± 9.7 years. The VA group was further subdivided according to the B. Lown and M. Wolf classification: Class I–II of VA (n = 20) Class III (n = 16) Class IV–V (n = 22).

Results. Standard echocardiographic parameters did not differ significantly between patients with and without VA. Multivariate analysis of variance demonstrated no statistically significant differences in left ventricular global longitudinal strain (GLS) (F = 1.234; p = 0.334). However, patients with class IV–V of VA showed significantly higher MD values (F = 96.149; p < 0.001).A statistically significant moderate positive correlation (Chaddock scale) was found between MD and the number of premature ventricular contractions (PVCs) (r = 0.46; p < 0.001). Each additional PVC was associated with an increase in MD by 0.002 ms. ROC curve analysis for the prediction of VAs by MD demonstrated an area under the curve (AUC) of 0.905 ± 0.033 (95% CI: 0.841–0.969; p < 0.001). The optimal MD cutoff value was 14.95 ms. MD ≥14.95 ms predicted a high risk of ventricular arrhythmias with a sensitivity of 84.5% and specificity of 81.8%.

Conclusions. Mechanical dispersion was significantly higher in patients with ventricular arrhythmias, whereas GLS did not differ between groups. MD ≥14.95 ms was associated with an increased risk of ventricular arrhythmias in patients after MI. These findings highlight the clinical value of 2D speckle-tracking echocardiography with MD assessment for risk stratification of ventricular arrhythmias in CAD patients.