Abnormal Global Longitudinal Strain Predicts Future Deterioration of Left Ventricular Function in Heart Failure Patients With a Recovered Left Ventricular Ejection Fraction

Abstract

Background Patients with recovery of left ventricular ejection fraction (LVEF) remain at risk for future deterioration of LVEF. However, there are no tools to risk stratify these patients. We hypothesized that global longitudinal strain could predict sustained recovery within this population. Methods and Results We retrospectively identified 96 patients with a reduced LVEF < 50% (screening echocardiogram), whose LVEF had increased by at least 10 % and normalized (>50%) on evidence based medical therapies (baseline echocardiogram). We examined absolute global longitudinal strain (GLS) on the baseline echocardiogram in relation to changes in LVEF on a follow-up echocardiogram. Patients with recovered LVEF had a wide range of GLS. The GLS on the baseline study correlated with the LVEF at the time of follow-up (r=0.33, p<0.001). The likelihood of having an LVEF >50% on follow-up increased by 24% for each point increase in absolute GLS on the baseline study (OR 1.24, p=0.001). An abnormal GLS (≤ 16%) at baseline had a sensitivity of 88%, a specificity of 46%, and an accuracy of 0.67 (p<0.001) as a predictor of a decrease in LVEF > 5% during follow up. A normal GLS (> 16%) on the baseline study had a sensitivity of 47%, a specificity of 83% and an accuracy of 0.65 (p=0.002) for predicting a stable LVEF (−5 to 5 %) on follow-up. Conclusions In patients with a recovered LVEF, an abnormal GLS predicts the likelihood of having a decrease LVEF during follow-up, whereas a normal GLS predicts the likelihood of stable LVEF during recovery.

Layer-specific speckle tracking analysis of left ventricular systolic function and synchrony in maintenance hemodialysis patients

“…To overcome increases in pre-and post-load, the LV develops physiological cardiac hypertrophy at an early stage to maintain normal cardiac output in MHD patients (22)(23). In line with the above observations, we found that MHD patients had significantly lower E/A but higher E/e' compared to healthy subjects, indicating that MHD patients exhibited slightly abnormal early stage LV diastolic function, which was likely associated with LV hypertrophy (24)(25), myocardial fibrosis (14), and/or left atrial dysfunction (26).…”

Reverse remodeling in Dilated Cardiomyopathy: Insights and future perspectives

“…In a sizeable portion of patients (up to 15%), LVRR was pronounced enough to result in a normalization of both LVEF and LV diameters, in a process that has been referred to as “apparent healing” or “myocardial remission” [ 20 ]. Interestingly, only about 10% of DCM patients showed persistent apparent healing at long term (>10 years) [ 21 ] and the vast majority of them experienced a recurrence of left ventricular dysfunction in the very long term, showing that the observed healing was only apparent and that true myocardial recovery is at most a rare event in DCM patients [ 21 , 22 ]. The mechanistic basis of apparent healing remains largely unknown.…”

Layer-specific speckle tracking analysis of left ventricular systolic function and synchrony in maintenance hemodialysis patients

“…Early studies have shown that the overall LS obtained by 2D-STE has become an objective and sensitive indicator for quantitative analysis of small changes in LV systolic function [24], which can be used to detect changes in regional myocardial blood supply earlier than LVEF [25]. LST based on 2D-STE technology is a new modality for evaluating wall motion.…”