Background A pattern of reduced basal longitudinal strain (BLS) is often observed in hypertension (HT) and with altered left ventricular (LV) geometry. Whether this pattern is associated with poor outcome is unclear. We hypothesized that BLS becomes incrementally more impaired in the transition from HT to LV hypertrophy (LVH) and is a predictor of outcome. Methods We investigated 1,096 participants from a community-based cohort study who had an echocardiogram with speckle tracking performed. Regional strain was calculated as: BLS, midventricular and apical strain. The participants were stratified by LV geometry: LVH vs. non-LVH (LVH defined as left ventricular mass index >116 g/m2 for men and >96g/m2 for women). Outcome was major adverse cardiovascular events (MACE) defined as incident myocardial infarction, heart failure, and cardiovascular death. Results BLS and midventricular strain were significantly reduced when comparing normal participants without HT to participants with HT, whereas only BLS was reduced when comparing participants with HT to those with LVH (figure). Overall, patients with LVH showed both reduced BLS and midventricular strain (BLS: −17.5 vs −19.2%, p<0.001; midventricular strain: −19.2 vs. −19.9%, p=0.007 for LVH and non-LVH, respectively) compared to non-LVH, whereas apical strain was similar between groups. During a median follow-up of 12.9 years (13.5; 14.9 years) there were 139 events. Only BLS was reduced in patients with MACE (BLS: −18.0 vs −19.1%, p=0.002) compared to patients without outcome. Both BLS and midventricular strain were univariable predictors of MACE in patients with LVH (BLS: HR=1.20 [1.04; 1.20], p=0.002; midventricular strain: HR=1.08 [1.00; 1.17], p=0.049) but not in patients without LVH (BLS: HR=1.02 [0.97; 1.08], p=0.46; midventricular strain: HR=1.01 [0.94; 1.07], p=0.88). Both measures were independent predictors after multivariable adjustment for clinical risk factors: age, gender, smoking, hypertension, and cholesterol (BLS: HR=1.08 [1.00; 1.16, p=0.048; midventricular strain: HR=1.10 [1.00; 1.20], p=0.049). Regional strain by HT and LV geometry Conclusion BLS and midventricular strain, but not apical strain, becomes incrementally impaired in the transition from normal to LVH, and is associated with poor outcome. In regional strain analyses, BLS provides the highest predictive value for outcome in patients with LVH. Acknowledgement/Funding None
Introduction Parameters derived from left atrial (LA) speckle tracking such as LA peak reservoir strain and LA dyssynchrony are potent predictors of cardiovascular morbidity and mortality in various patient populations. However, whether LA dyssynchrony as evaluated by speckle tracking is associated with long-term outcome in the general population is currently unknown. Methods In a cohort study with participants from the general population 385 participants without atrial fibrillation (AF), ischemic heart disease (IHD), heart failure (HF) or previous ischemic stroke (IS) had a health examination and an echocardiogram, including LA speckle tracking, performed. LA dyssynchrony was defined as the standard deviation of the time to peak regional atrial reservoir strain values. The endpoints were all-cause mortality, a combined endpoint of AF and IS, and a combined endpoint of major adverse cardiovascular events (MACE) comprised of acute myocardial infarction (AMI), HF or cardiovascular death (CVD). Results Median LA dyssynchrony was 42 ms (IQR: 22–58 ms), 60% percent of included participants were women, mean age was 55 years (SD 16 years), 34% had hypertension and 7% had diabetes mellitus. During a median follow up of 16.1 years (IQR 15.0–16.3 years), 83 (22%) participants died, 60 (15%) reached the composite endpoint of AF and IS, and 38 (10%) reached the composite MACE endpoint. Increasing LA dyssynchrony was associated with increasing age, lower estimated glomerular filtration rate, lower E/A ratio, lower e' and higher E/e'. In a univariable Cox regression, LA dyssynchrony was a significant predictor of all-cause mortality (HR 1.07, 95% CI 1.02–1.11, p=0.001, per 10 ms increase) but was not significantly associated with the combined endpoint of AF and IS (HR 1.05, 95% CI 1.00–1.10, p=0.064, per 10 ms increase) nor MACE (HR 1.04, 95% CI 0.98–1.12, p=0.22, per 10 ms increase). However, when adjusted for age, LA dyssynchrony did not predict all-cause mortality (HR 1.03, p=0.28), the combined endpoint of AF and IS (HR 1.01, p=0.83), or MACE (HR 0.99, p=0.88,). Similarly, after further adjustment for age, sex, smoking status, systolic blood pressure and cholesterol, LA dyssynchrony did not predict any of the study outcomes (All-cause mortality: HR 1.01, p=0.72) (AF and IS: HR 0.98, p=0.88) (MACE: HR 1.00, p=0.93). Conclusion In this general population study, LA dyssynchrony was not an independent predictor of all-cause mortality and did not predict MACE nor a composite outcome consisting of AF and IS.
Background Global longitudinal strain (GLS) of the left ventricle (LV) has proved to be a strong predictor of cardiovascular morbidity and mortality. GLS declines throughout adult-life as the LV remodels and adapts. Information on the impact of cardiac risk factors such as male sex, obesity, smoking status, hypertension, hypercholesterolemia, and diabetes on GLS through time has not yet been investigated. Purpose The aim of the present study was to investigate the impact of age, sex, body mass index (BMI), smoking status (current and previous vs never), mean arterial blood pressure (MAP), total plasma cholesterol (TPC), and HbA1c on GLS in the general population over a 10-year period. Method A total of 689 citizens recruited from the general population participated in the 4th and 5th Copenhagen City Heart Study (CCHS4 and CCHS5) a prospective longitudinal study. At CCHS4 the mean age was 51 years and 45% were male. The average decline in GLS during the follow-up period was −0.65%. All participants underwent two echocardiographic examinations median 10.4 [IQR: 10.2, 10.9] years apart along with thorough health examinations. All analyses were adjusted for baseline GLS value (CCHS4 value). Results In regression models, increasing age, male sex, increasing BMI, MAP, hypertension, increasing HbA1c, and diabetes proved to be significantly associated with increased decline in GLS. Relationship between significant continuous cardiovascular risk factors and ΔGLS are displayed in restricted spline curves (Figure 1). In a multivariable regression model including all the investigated cardiovascular risk factors, estimated glomerular filtration rate, plasma pro B-type natriuretic peptide, heart rate, and previous ischemic heart disease, age (standardized β-coef. = −0.10, P=0.005), male sex (standardized β-coef. = −0.16, P<0.001), and MAP (standardized β-coef. = −0.07, P=0.009) remained independent predictors of an accelerated decline in GLS during a 10-year period. Restricted cubic spline curves Conclusion In the general population increasing age, male sex, and increasing MAP are all independently associated with an accelerated decline in GLS over a 10-year period.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.