Clinical InvestigationLeft Ventricular Strain Mechanics: Clinical ApplicationAssociation of Left Ventricular Strain with 30-Day Mortality and Readmission in Patients with Heart Failure
Section snippets
Study Subjects
Using administrative data, we retrospectively identified 1,235 consecutive first admissions with congestive HF (admission codes I500 [congestive HF], I501 [LV failure], and I509 [HF, unspecified]) at Royal Hobart Hospital and Launceston General Hospital, the two major referral hospitals in Tasmania, from July 2009 to June 2012. At these hospitals, patients with HF with other comorbidities are usually admitted under the care of the general medical team with related subspecialty input. The study
Patient Characteristics
Of the 1,235 admissions, we identified 659 patients who underwent inpatient echocardiography. After the exclusion of patients with suboptimal echocardiographic image quality (n = 45), inability to evaluate strain because of irregular heart rate in the acquired images (mainly atrial fibrillation; n = 132), and death during the index hospitalization (n = 14), the final analysis was based on data from 468 patients (Figure 1).
Events
Follow-up data were available in all 468 patients, with 92 events (20%)
Discussion
In this assessment of the predictors of 30-day all-cause death or readmission using echocardiographic data in patients with first admissions with HF, the association of GLS with outcome provided independent and incremental value over clinical and basic echocardiographic parameters. Importantly, GLS appeared most useful for identifying the patients with HFpEF at high risk for 30-day outcome. The predictive role of GLS is particularly promising in the context of current interest in risk
Conclusions
GLS is associated with 30-day all-cause death or readmission in patients with HF, especially in patients with preserved EF. This effect is independent of and incremental to clinical and basic echocardiographic parameters.
Acknowledgment
The authors gratefully acknowledge the assistance of Dr Tomoko Negishi for the calculation of strain reproducibility.
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This study was supported in part by a Partnership grant (1059738) from the National Health and Medical Research Council (Canberra, Australia).