Global Longitudinal Strain Predicts Poor Functional Capacity in Patients with Systolic Heart Failure

Abstract

BackgroundLeft ventricular global longitudinal strain value (GLS) can predict functional capacity in patients with preserved left ventricular ejection fraction (LVEF) heart failure (HF) and to assess prognosis in reduced LVEF HF.ObjetiveCorrelate GLS with parameters of Cardiopulmonary Exercise Test (CPET) and to assess if they could predict systolic HF patients that are more appropriated to be referred to heart transplantation according to CPET criteria.MethodsSystolic HF patients with LVEF < 45%, NYHA functional class II and III, underwent prospectively CPET and echocardiography with strain analysis. LVEF and GLS were correlated with the following CPET variables: maxVO2, VE/VCO2 slope, heart rate reduction during the first minute of recovery (HRR) and time needed to reduce maxVO2 in 50% after physical exercise (T1/2VO2). ROC curve analysis of GLS to predict VO2 < 14 mL/kg/min and VE/VCO2 slope > 35 (heart transplantation’s criteria) was performed.ResultsTwenty six patients were selected (age, 47 ± 12 years, 58% men, mean LVEF = 28 ± 8%). LVEF correlated only with maxVO2 and T1/2VO2. GLS correlated to all CPET variables (maxVO2: r = 0.671, p = 0.001; VE/VCO2 slope: r = -0.513, p = 0.007; HRR: r = 0.466, p = 0.016, and T1/2VO2: r = -0.696, p = 0.001). GLS area under the ROC curve to predict heart transplantation’s criteria was 0.88 (sensitivity 75%, specificity 83%) for a cut-off value of -5.7%, p = 0.03.ConclusionGLS was significantly associated with all functional CPET parameters. It could classify HF patients according to the functional capacity and may stratify which patients have a poor prognosis and therefore to deserve more differentiated treatment, such as heart transplantation.

Diagnostic Accuracy of Global Longitudinal Strain for Detecting Exercise Intolerance in Patients with Ischemic Heart Disease

“…Hence, determination of the relationship between GLS and exercise intolerance could potentially allow the prediction of CRF of patients with IHD based solely on ECG-derived GLS. The exercise intolerance prediction results from this study extend the findings of Maia et al [ 40 ] regarding GLS measured in patients with systolic heart failure. In this study, the GLS cut-off value for detecting a peak VO 2 of <14 mL/min/kg was −15.2.…”

Different cardiac performance in severe and mild patients with COVID-19 by standard and strain echocardiography

“…And it could classify HF patients according to the functional capacity. 25 In this study, we found that GLS had a low predicted value of the disease severity, which may stratify the patients with unknown condition and therefore to deserve more differentiated treatment.…”

At Last, a Sensitive Method to Detect Incipient Systolic Dysfunction!

“…The mean value of the percentage of longitudinal deformation of each segment is what we call the global longitudinal strain (GLS) and this index has shown to be an excellent parameter for systolic function evaluation, which is sensitive enough to detect incipient impairment when the ejection fraction is still normal and has a higher prognostic value than EF in many clinical situations. [5][6][7] In this issue of the Brazilian Archives of Cardiology, Dr. Ronaldo Campos Rodrigues presents us with an excellent work, in which left ventricular systolic function was assessed by quantifying GLS in HIV-positive patients, with and without antiretroviral therapy, compared with a control group. 8 It was observed that GLS values were significantly lower in infected individuals than in control ones, regardless of whether or not they were undergoing treatment.…”