Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction

Kalam, Kashif; Otáhal, Petr; Marwick, Thomas H.

doi:10.1136/heartjnl-2014-305538

Cited by 826 publications

(630 citation statements)

References 32 publications

(26 reference statements)

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“…There were consistent cardiac hemodynamic responses to glucose with increases in SV and CO and an improvement in GLS; the latter is a robust marker of global left ventricular function and diminished GLS is recognized as a predictor of adverse cardiac events (Kalam et al. 2014). These responses were not influenced by PPH.…”

Section: Discussionmentioning

confidence: 99%

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

et al. 2017

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Postprandial hypotension (PPH) occurs frequently and is thought to reflect an inadequate increase in cardiac output to compensate for the rise in splanchnic blood flow after a meal. Gastric distension by water attenuates the postprandial fall in blood pressure (BP). Cardiac hemodynamics (stroke volume (SV), cardiac output (CO), and global longitudinal strain (GLS)) have hitherto not been measured in PPH. We sought to determine the comparative effects of water and glucose drinks on cardiac hemodynamics in healthy older subjects and individuals with PPH. Eight healthy older subjects (age 71.0 ± 1.7 years) and eight subjects with PPH (age 75.5 ± 1.0 years) consumed a 300 mL drink of either water or 75 g glucose (including 150 mg 13C‐acetate) in randomized order. BP and heart rate (HR) were measured using an automatic device, SV, CO, and GLS by transthoracic echocardiography and gastric emptying by measurement of 13 CO 2. In both groups, glucose decreased systolic BP (P < 0.001) and increased HR, SV, and CO (P < 0.05 for all). The fall in systolic BP was greater (P < 0.05), and increase in HR less (P < 0.05), in the PPH group, with no difference in SV or CO. Water increased systolic BP (P < 0.05) in subjects with PPH and, in both groups, decreased HR (P < 0.05) without affecting SV, CO, or GLS. In subjects with PPH, the hypotensive response to glucose and the pressor response to water were related (R = −0.75, P < 0.05). These observations indicate that, in PPH, the hypotensive response to oral glucose is associated with inadequate compensatory increases in CO and HR, whereas the pressor response to water ingestion is maintained and, possibly, exaggerated.

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Section: Discussionmentioning

confidence: 99%

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

et al. 2017

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“…In prospective studies, GLS has been shown to be superior to ejection fraction (EF) in predicting mortality in patients with previous CVD or chronic kidney disease (28,29). In terms of diastolic function, e′/a′ ratio is known to be related to stiffness of the left ventricle, and to be impaired in insulin resistance (30) and diabetes (31).…”

Section: Discussionmentioning

confidence: 99%

suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease

Theilade

Rossing

Eugen‐Olsen

et al. 2016

European Journal of Endocrinology

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Aim Heart disease is a common fatal diabetes-related complication. Early detection of patients at particular risk of heart disease is of prime importance. Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker for development of cardiovascular disease. We investigate if suPAR is associated with early myocardial impairment assessed with advanced echocardiographic methods. Methods In an observational study on 318 patients with type 1 diabetes without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF >45%), we performed conventional, tissue Doppler and speckle tracking echocardiography, and measured plasma suPAR levels. Associations between myocardial function and suPAR levels were studied in adjusted models including significant covariates. Results Patients were 55±12 years (mean±s.d.) and 160 (50%) males. Median (interquartile range) suPAR was 3.4 (1.7) ng/mL and LVEF was 58±5%. suPAR levels were not associated with LVEF (P=0.11). In adjusted models, higher suPAR levels were independently associated with both impaired systolic function assessed with global longitudinal strain (GLS) and tissue velocity s′, and with impaired diastolic measures a′ and e′/a′ (all P=0.034). In multivariable analysis including cardiovascular risk factors and both systolic and diastolic measures (GLS and e′/a′), both remained independently associated with suPAR levels (P=0.012). Conclusions In patients with type 1 diabetes with normal LVEF and without known heart disease, suPAR is associated with early systolic and diastolic myocardial impairment. Our study implies that both suPAR and advanced echocardiography are useful diagnostic tools for identifying patients with diabetes at risk of future clinical heart disease, suited for intensified medical therapy.

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“…In summary, strain provides robust, operator-independent data on LV systolic function, which can be more sensitive in detecting systolic function impairment than classical 2-dimension echocardiography. In a recent meta-analysis including 16 studies and 5,721 patients [16], global longitudinal strain impairment was more robust than LVEF in the prediction of death or major cardio-vascular events in cardiology, underlining the importance that STE will take in the next years.…”

Section: Clinical Applications Of Ste For Myocardial Deformation Assementioning

confidence: 99%

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Cinotti¹,

Delater²,

Fortuit³

et al. 2015

Anaesthesiol Intensive Ther

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Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its novelty relies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium during the cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date, global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is more sensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment. It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensive care unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-tracking analysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggest that GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients, speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gaps to fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated, and there are, to date, too few data to exactly assess potential GLS alterations on the patient's outcome. Nonetheless, this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may be of primary interest in the evaluation of left-ventricular systolic function in the ICU.

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Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction

Abstract: There is strong evidence of the prognostic value of GLS, which appears to have superior prognostic value to EF for predicting major adverse cardiac events.

Cited by 826 publications

References 32 publications

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

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