Global longitudinal strain can predict heart failure exacerbation in stable outpatients with ischemic left ventricular systolic dysfunction

Kaufmann, Damian; Szwoch, Małgorzata; Kwiatkowska, Joanna; Raczak, Grzegorz; Daniłowicz‐Szymanowicz, Ludmiła

doi:10.1371/journal.pone.0225829

Cited by 24 publications

(13 citation statements)

References 38 publications

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“…Our data demonstrate the clinical utility of RV-FWS and RA-GS as echocardiographic parameters that aid in this task. Strain parameters have been previously used to predict outcomes in congestive heart failure and myocardial infarction with similar results ( 21 , 22 ), as well as in PH ( 23 – 25 ). The echocardiographic estimation of sPAP and accordingly the development of the probability of PH is usually predicated on the presence of a complete tricuspid regurgitation envelope by continuous-wave Doppler.…”

Section: Discussionmentioning

confidence: 96%

Right Heart Chambers Longitudinal Strain Provides Enhanced Diagnosis and Categorization in Patients With Pulmonary Hypertension

Espínola‐Zavaleta

Antonio-Villa

Guerra

et al. 2022

Front. Cardiovasc. Med.

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BackgroundIncreased systolic pulmonary arterial pressure (sPAP) could lead to the mechanical dysfunction and myocardial fibrosis of the right heart chambers. Echocardiographic strain analysis has not been adequately studied in patients with pulmonary hypertension (PH).Study design and methodsA cross-sectional cohort of patients with suspected PH and echocardiographic strain evaluation was recruited. The cut-off values of peak tricuspid regurgitation velocity (TRV) with the low probability of PH (≤2.8 m/s), intermediate probability (2.9–3.4 m/s, without other echo PH signs), and high probability of PH (2.9–3.4 m/s with other echo PH signs and >3.4 m/s) categories were studied by right ventricular and right atrial (RA) strain analysis in a sample of 236 patients.ResultsThe results showed that 58 (56.9%) patients had low, 15 (14.7%) had intermediate, and 29 (28.4%) had a high probability of PH. We observed a negative association between right ventricular free wall strain (RV-FWS) and atrial global strain with sPAP. With the increase in PH severity, RA reservoir, conduit, and contraction (booster) strain values decreased. The identified cut-off values of strain parameters had an adequate ability to detect PH severity categories. In addition, the post-mortem biopsies of right heart chambers from subjects with known severe PH were analyzed to quantify myocardial fibrosis. Our sample of right heart biopsies (n = 12) demonstrated an association between increased sPAP before death and right ventricular and RA fibrosis.ConclusionMechanical dysfunction and fibrosis in the right chambers are associated with increased sPAP. Right ventricular and atrial strain could provide enhancement in the diagnosis and categorization of subjects with suspected PH.

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Section: Discussionmentioning

confidence: 96%

Right Heart Chambers Longitudinal Strain Provides Enhanced Diagnosis and Categorization in Patients With Pulmonary Hypertension

Espínola‐Zavaleta

Antonio-Villa

Guerra

et al. 2022

Front. Cardiovasc. Med.

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“…Herewith, this study confirms and increases previous evidence on the added prognostic value of GLS over LVEF. Several studies have shown that “baseline” GLS carries prognostic value over LVEF ( 1 , 3 , 5 , 7 ). A meta-analysis by Kamal et al ( 3 ) showed that baseline GLS was more strongly associated with mortality than LVEF.…”

Section: Discussionmentioning

confidence: 99%

“…Global longitudinal strain (GLS) is independently associated with all-cause mortality, cardiovascular death and heart transplantation ( 2 , 5 , 6 ), and also predicts risk of HF hospitalization ( 4 , 7 ). When compared to LVEF, GLS has incremental prognostic value ( 3 , 8 , 9 ) and carries potential to be used as a standard measurement for chronic HF ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of temporal patterns of global longitudinal strain in patients with chronic heart failure

Kamar

Aga

Bakker

et al. 2023

Front. Cardiovasc. Med.

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BackgroundWe investigated whether repeatedly measured global longitudinal strain (GLS) has incremental prognostic value over repeatedly measured left ventricular ejection fraction (LVEF) and N-terminal pro B-type natriuretic peptide (NT-proBNP), and a single “baseline” GLS value, in chronic heart failure (HF) patients.MethodsIn this prospective observational study, echocardiography was performed in 173 clinically stable chronic HF patients every six months during follow up. During a median follow-up of 2.7 years, a median of 3 (25th–75th percentile:2–4) echocardiograms were obtained per patient. The endpoint was a composite of HF hospitalization, left ventricular assist device, heart transplantation, cardiovascular death. We compared hazard ratios (HRs) for the endpoint from Cox models (used to analyze the first available GLS measurements) with HRs from joint models (which links repeated measurements to the time-to-event data).ResultsMean age was 58 ± 11 years, 76% were men, 81% were in New York Heart Association functional class I/II, and all had LVEF < 50% (mean ± SD: 27 ± 9%). The endpoint was reached by 53 patients. GLS was persistently decreased over time in patients with the endpoint. However, temporal GLS trajectories did not further diverge in patients with versus without the endpoint and remained stable during follow-up. Both single measurements and temporal trajectories of GLS were significantly associated with the endpoint [HR per SD change (95%CI): 2.15(1.34–3.46), 3.54 (2.01–6.20)]. In a multivariable model, repeatedly measured GLS maintained its prognostic value while repeatedly measured LVEF did not [HR per SD change (95%CI): GLS:4.38 (1.49–14.70), LVEF:1.14 (0.41–3.23)]. The association disappeared when correcting for repeatedly measured NT-proBNP.ConclusionTemporal evolution of GLS was associated with adverse events, independent of LVEF but not independent of NT-proBNP. Since GLS showed decreased but stable values in patients with adverse prognosis, single measurements of GLS provide sufficient information for determining prognosis in clinical practice compared to repeated measurements, and temporal GLS patterns do not add prognostic information to NT-proBNP.

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“…1,10,30 Several relevant risk factors for poorer HF prognosis have been reported and those were confirmed in our study. 13,[31][32][33][34][35][36][37][38][39] The MADIT II (Multicenter Automatic Defibrillator Implan tation Trial II) cohort analysis identified re nal failure as one of the strongest predictors of poor prognosis. 35 Gheorghiade et al 36 and Ambrosy et al 37 listed renal failure and low systolic blood pressure among factors influ encing the prognosis of patients hospitalized for HF.…”

Section: Supplementary Materialsmentioning

confidence: 99%

Two-year prognosis of patients hospitalized for decompensated heart failure in a district general hospital

Dobrowolska¹,

Miękus²,

Świątczak

et al. 2021

Kardiol Pol

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Background Patients hospitalized for heart failure (HF) exacerbation tend to have a poor prognosis. Most previous studies were performed in large clinical centers and detailed analyses of patients with HF hospitalized in district general hospitals are lacking. aims The aim of this study was to assess the outcomes of patients admitted with HF exacerbation to a district general hospital. methods We retrospectively enrolled patients hospitalized for HF exacerbation in the years 2010 to 2011 (191 patients) and 2016 to 2017 (203 patients). The primary and secondary endpoints were all -cause mortality and rehospitalization due to HF exacerbation, respectively, within a 2-year follow -up. results Compared with patients hospitalized from 2010 to 2011, those hospitalized from 2016 to 2017 had more favorable clinical parameters and more appropriate pharmacological treatment; however, the rate of implantable cardioverter -defibrillator and resynchronization device use remained low. The overall mortality decreased from 44% between 2010 and 2011 to 33% between 2016 and 2017 (P = 0.03), but the number of rehospitalizations increased from 26% to 41%, respectively (P <0.001). Male sex, low systolic blood pressure, symptoms of right HF, and renal dysfunction were independent risk factors for the primary endpoint. Symptoms of right HF, renal dysfunction, left ventricular ejection fraction below 24%, and low systolic blood pressure independently predicted the secondary endpoint. conclusions The prognosis of patients hospitalized for decompensated HF in a regional district hospital was poor. Despite some improvement in pharmacological treatment, which probably led to reduced all--cause mortality, there was a low rate of implantable electronic device use and a high rate of rehospitalizations due to HF exacerbation, which needs further elucidation.

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Global longitudinal strain can predict heart failure exacerbation in stable outpatients with ischemic left ventricular systolic dysfunction

Cited by 24 publications

References 38 publications

Right Heart Chambers Longitudinal Strain Provides Enhanced Diagnosis and Categorization in Patients With Pulmonary Hypertension

Right Heart Chambers Longitudinal Strain Provides Enhanced Diagnosis and Categorization in Patients With Pulmonary Hypertension

Prognostic value of temporal patterns of global longitudinal strain in patients with chronic heart failure

Two-year prognosis of patients hospitalized for decompensated heart failure in a district general hospital

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Global longitudinal strain can predict heart failure exacerbation in stable outpatients with ischemic left ventricular systolic dysfunction

Cited by 24 publications

References 38 publications

Right Heart Chambers Longitudinal Strain Provides Enhanced Diagnosis and Categorization in Patients With Pulmonary Hypertension

Right Heart Chambers Longitudinal Strain Provides Enhanced Diagnosis and Categorization in Patients With Pulmonary Hypertension

Prognostic value of temporal patterns of global longitudinal strain in patients with chronic heart failure

Two-­year prognosis of patients hospitalized for decompensated heart failure in a district general hospital

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Two-year prognosis of patients hospitalized for decompensated heart failure in a district general hospital