Clinical Investigation
Heart Failure
Global Longitudinal Strain as a Major Predictor of Cardiac Events in Patients with Depressed Left Ventricular Function: A Multicenter Study

https://doi.org/10.1016/j.echo.2010.07.019Get rights and content

Background

The risk stratification of patients with left ventricular (LV) dysfunction can be performed using echocardiographic parameters such as the ejection fraction (EF). Recently, new technologies based on deformation measurements have been shown to identify early myocardial dysfunction before EF decrease. Consequently, tools such as two-dimensional strain have been incorporated into echocardiographic systems, allowing for fast, reliable, and reproducible calculation of longitudinal components of LV systolic deformation. The hypothesis in this study was that as a more sensitive marker of LV dysfunction, longitudinal strain would allow for the risk stratification of patients with heart failure.

Methods

This multicenter study included 147 patients with heart failure with LV EFs ≤ 45% (mean age, 64 ± 14 years; 74% men; mean LV EF, 29.9 ± 8.9%). Conventional echocardiographic parameters as well as global and segmental longitudinal strain were measured and compared with these values in a control population. Patients were monitored for cardiac events, defined as a composite criterion, over 12 months.

Results

Clinical events were observed in 20% of patients during the 12-month follow-up period. On receiver operating characteristic curve analysis, global longitudinal strain had the highest prognostic value (area under the curve, 0.83) and the highest combination of sensitivity (73%) and specificity (83%), using a cutoff value of −7%.

Conclusion

Strain assessment is highly feasible and reliable in patients with LV dysfunction and allows for cardiovascular risk stratification in patients with heart failure with greater accuracy than LV EF.

Section snippets

Patient Population

One hundred eighty-one patients with chronic cardiomyopathy and LV EFs ≤ 45% were enrolled in a prospective multicenter study between January and November 2007 (Cardiologic Hospital and INSERM 828, Bordeaux University Hospital Center, Pessac, France; Timone Hospital, Cardiology Department, Marseille, France; and Pontchaillou University Hospital Center, Rennes, France). The exclusion criteria were recent acute HF (<3 months with clinical congestive HF), unstable patients (cardiac shock), severe

Patient Characteristics at Baseline

The study population’s baseline characteristics are shown in Table 1. The mean age was 64.5 ± 14 years, 74% were men, and 42.8% presented with ischemic cardiomyopathy. Most patients were in NYHA class II at the time of inclusion. The mean QRS interval was 135 ± 35 msec, while the mean LV EF was 29.9 ± 8.9%.

Patient Characteristics and Echocardiographic Parameters According to Cardiac Events

Characteristics of patients with HF and conventional echocardiographic parameters according to cardiac events are shown in Table 2. Overall, 20% of patients had cardiac events at the end of

Discussion

Our study demonstrates the prognostic significance of 2D GLS in a population of patients with chronic cardiomyopathy and LV dysfunction. The main results are as follows: (1) the GLS technique is a simple and highly feasible tool, with good reproducibility when applied to patients with LV dysfunction; (2) with a cutoff value of −7%, GLS can discriminate between patients with cardiac events and those with a better prognosis; and (3) regarding the evaluation of patient risk, longitudinal

Conclusions

GLS can be easily and robustly measured in patients with HF, demonstrating greater feasibility than other conventional parameters. Among prognostic factors obtained by echocardiography, GLS is the best predictor of cardiac events in this patient population. Our findings suggest a cutoff value of −7% to predict cardiac events at 12 months with high sensitivity and specificity. A multiparametric approach including GLS could better risk-stratify patient risk with HF than single-parameter

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