Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure

Cho, Goo-Yeong; Marwick, Thomas H.; Kim, Hyun‐Sook; Kim, Minkyu; Hong, Kyung-Soon; Oh, Dong-Jin

doi:10.1016/j.jacc.2009.04.061

Cited by 421 publications

(301 citation statements)

References 22 publications

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“…In 201 patients with heart failure (number of patients with CKD not stated), Cho et al reported that global circumferential strain is an independent and better predictor of cardiac events (readmission for heart failure or cardiac death) than left ventricular ejection fraction. 52 Several studies described a reduction of left ventricular strain parameters in patients with CKD or ESRD despite preserved left ventricular ejection fraction. [53][54][55] Edwards et al reported that patients with early-stage CKD (CKD stages 2-3) have impaired systolic strain and strain rate values (assessed by Figure 4.…”

Section: Discussionmentioning

confidence: 99%

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Kramann¹,

Erpenbeck²,

Schneider

et al. 2014

Journal of the American Society of Nephrology

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Cardiovascular mortality is high in ESRD, partly driven by sudden cardiac death and recurrent heart failure due to uremic cardiomyopathy. We investigated whether speckle-tracking echocardiography is superior to routine echocardiography in early detection of uremic cardiomyopathy in animal models and whether it predicts cardiovascular mortality in patients undergoing dialysis. Using speckle-tracking echocardiography in two rat models of uremic cardiomyopathy soon (4-6 weeks) after induction of kidney disease, we observed that global radial and circumferential strain parameters decreased significantly in both models compared with controls, whereas standard echocardiographic readouts, including fractional shortening and cardiac output, remained unchanged. Furthermore, strain parameters showed better correlations with histologic hallmarks of uremic cardiomyopathy. We then assessed echocardiographic and clinical characteristics in 171 dialysis patients. During the 2.5-year follow-up period, ejection fraction and various strain parameters were significant risk factors for cardiovascular mortality (primary end point) in a multivariate Cox model (ejection fraction hazard ratio [HR], 0.97 [95% confidence interval (95% CI), 0.95 to 0.99; P=0.012]; peak global longitudinal strain HR, 1.17 [95% CI, 1.07 to 1.28; P,0.001]; peak systolic and late diastolic longitudinal strain rates HRs, 4.7 [95% CI, 1.23 to 17.64; P=0.023] and 0.25 [95% CI, 0.08 to 0.79; P=0.02], respectively). Multivariate Cox regression analysis revealed circumferential early diastolic strain rate, among others, as an independent risk factor for all-cause mortality (secondary end point; HR, 0.43; 95% CI, 0.25 to 0.74; P=0.002). Together, these data support speckle tracking as a postprocessing echocardiographic technique to detect uremic cardiomyopathy and predict cardiovascular mortality in ESRD.

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Section: Discussionmentioning

confidence: 99%

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Kramann¹,

Erpenbeck²,

Schneider

et al. 2014

Journal of the American Society of Nephrology

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“…However, there are few studies of LV strain and outcomes in community‐dwelling individuals free of overt CVD 10, 11. Furthermore, the degree to which distinct components of LV deformation in various planes provide specific prognostic information regarding risk of individual CVD outcomes (eg, coronary disease vs. HF) remains unclear 12, 13…”

Section: Introductionmentioning

confidence: 99%

Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

Cheng

McCabe

Larson

et al. 2015

JAHA

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BackgroundThere are few data relating novel measures of left ventricular (LV) mechanical function to cardiovascular disease (CVD) outcomes in the community. Whether distinct components of LV mechanical function provide information regarding risk for different CVD outcomes is unclear.Methods and ResultsWe used speckle tracking echocardiography to quantify distinct components of LV mechanical function (measured as LV strain in multiple planes) in 2831 Framingham Offspring Study participants (mean age, 66 years; 57% women, 97% with LV fractional shortening >0.29). Participants were followed for 6.0±1.2 years for onset of 69 coronary heart disease (CHD), 71 heart failure (HF), and 199 mortality events. Adjusting for CVD risk factors, longitudinal LV strain appeared associated with incident CHD (hazards ratio [HR] per SD increment, 1.29; 95% confidence interval [CI], 1.00–1.67; P=0.05), whereas circumferential and radial strain were not (P>0.37 for both); however, the association of longitudinal strain with CHD was nonsignificant after Bonferroni correction. By contrast, circumferential strain was a significant predictor of incident HF (HR per SD increment, 1.79; 95% CI, 1.35–2.37; P<0.0001). Decrements in circumferential, radial, and longitudinal strain measures were related to all‐cause mortality (P<0.008 for all). Results remained similar in multivariable models adjusting additionally for the conventional echocardiographic measures of LV mass and fractional shortening.ConclusionsIn our large, community‐based sample, distinct components of LV mechanical function were associated with specific CVD outcomes. Additional studies are needed to replicate these findings and investigate the prognostic and therapeutic utility of these novel measures of LV mechanical function.

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“…It was recently reported that global circumferential strain (GCS) assessed by 2D speckle-tracking strain in the mid-LV short-axis view reflects LV intrinsic myocardial function, 18, 19 and constitutes an independent prognostic marker for the prediction of cardiovascular events regardless of markers of LV global function such as ejection fraction (EF) in HF patients. 19 Accordingly, our objective was to test the hypothesis that an easy-to-use comprehensive speckle-tracking approach that combined assessment of LV radial dyssynchrony and GCS ardiac resynchronization therapy (CRT) is an established therapeutic option for advanced heart failure (HF) patients with severe symptoms and wide QRS duration.…”

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confidence: 99%

Easy-to-Use Comprehensive Speckle-Tracking Approach for Cardiac Resynchronization Therapy

Mochizuki

Tanaka

Tatsumi

et al. 2014

Circ J

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Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure

Abstract: GCS is a powerful predictor of cardiac events and appears to be a better parameter than ejection fraction in patients with acute heart failure.

Cited by 421 publications

References 22 publications

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Speckle Tracking Echocardiography Detects Uremic Cardiomyopathy Early and Predicts Cardiovascular Mortality in ESRD

Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

Easy-to-Use Comprehensive Speckle-Tracking Approach for Cardiac Resynchronization Therapy

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