Clinical Research
Heart Failure
Incremental Prognostic Value of Assessing Left Ventricular Myocardial Mechanics in Patients With Chronic Systolic Heart Failure

https://doi.org/10.1016/j.jacc.2012.07.047Get rights and content
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Objectives

This study sought to examine the ability of left ventricular (LV) global longitudinal strain (GLS) to assess disease severity in patients with chronic systolic heart failure (HF).

Background

Left ventricular GLS is a sensitive measure of LV mechanics. Its relationship with standard clinical markers and long-term adverse events in chronic systolic HF is not well established.

Methods

In 194 chronic systolic HF patients, we performed comprehensive echocardiography with assessment of GLS by velocity vector imaging averaged from apical 4-chamber and 2-chamber views. Death, cardiac transplantation, and HF hospitalization were tracked for 5 years.

Results

In our study cohort (age 57 ± 14 years, left ventricular ejection fraction [LVEF] 26 ± 6%, median N-terminal pro-B-type natriuretic peptide [NT-proBNP] 1,158 pg/ml), the mean GLS was −7.1 ± 3.3%. The GLS worsened with increasing New York Heart Association functional class (rank-sum p < 0.0001) and higher NT-proBNP (r = 0.42, p < 0.0001). The GLS correlated with LV cardiac structure (LV mass index: r = 0.35, p < 0.0001; LV end-diastolic volume index: r = 0.43, p < 0.0001) and LVEF (r = −0.66, p < 0.0001). A lower magnitude of GLS was associated with worsening LV diastolic function (E/e' septal: r = 0.33, p < 0.0001), right ventricular (RV) systolic function (RV s': r = −0.30, p < 0.0001), and RV diastolic function (RV e'/a': r = 0.16, p = 0.033). GLS predicted long-term adverse events (hazard ratio: 1.55, 95% confidence interval: 1.21 to 2.00; p < 0.001). Worsening strain (GLS ≥−6.95%) predicted adverse events after adjustment for age, sex, ischemic etiology, E/e' septal, and NT-proBNP (hazard ratio: 2.04, 95% confidence interval: 1.09 to 3.94; p = 0.025) and age, sex, ischemic etiology, and LVEF (hazard ratio: 2.15, 95% confidence interval: 1.19 to 4.02; p = 0.011).

Conclusions

In chronic systolic HF, worsening LV GLS is associated with more severe LV diastolic dysfunction and RV systolic and diastolic dysfunction, and provides incremental prognostic value to LVEF.

Key Words

global longitudinal strain
heart failure
prognosis

Abbreviations and Acronyms

a'
peak late diastolic velocity of the mitral annulus
e'
peak early diastolic velocity of the mitral annulus
EF
ejection fraction
GCS
global circumferential strain
GLS
global longitudinal strain
HF
heart failure
LV
left ventricle/left ventricular
NT-proBNP
N-terminal pro-B-type natriuretic peptide
NYHA
New York Heart Association
ROC
receiver-operating characteristic
RV
right ventricle/right ventricular
s'
peak systolic velocity of the mitral annulus

Cited by (0)

The ADEPT study was supported by the American Society of Echocardiography Outcomes Research Award and GlaxoSmithKline Pharmaceuticals. Dr. Tang is a consultant to and has received grant support from Medtronic, Inc., St. Jude Medical, and Abbott Laboratories. All other authors have reported they have no relationships relevant to the contents of this paper to disclose. John Gorcsan, MD, served as Guest Editor for this paper.