Impact of Longitudinal Myocardial Deformation on the Prognosis of Chronic Heart Failure Patients

Abstract

Background-Longitudinal myocardial deformation indexes appear superior to left ventricular ejection fraction (LVEF) in assessing myocardial contractility. However, few studies have addressed the prognostic value of longitudinal motion markers (velocity, strain, and strain rate) in predicting outcome in heart failure patients. Methods and Results-The study included 125 consecutive symptomatic heart failure patients (63Ϯ16 years, 77% male, LVEFϭ31Ϯ10%). All patients underwent a complete echocardiographic and clinical examination, and brain natriuretic peptide level was assessed in 93 patients. Longitudinal myocardial velocity by tissue Doppler imaging, global-, and strain rate by speckle tracking were computed from apical views (4-, 3-, and 2-chambers views) and compared with the occurrence of major adverse cardiac events. On the whole, peak longitudinal velocity, global-, and strain rate averaged 5Ϯ2 cm/s (range, 1 to 9), Ϫ8Ϯ3% (range, Ϫ3 to Ϫ18), and Ϫ0.33Ϯ0.16 s Ϫ1 (range, Ϫ0.83 to Ϫ0.05), respectively. During the follow-up period (266Ϯ177 days), major adverse cardiac events occurred in 47 (38%) patients (15 deaths, 29 recurrent heart failure, and 4 heart transplantations). By univariable analysis using Cox model global-, strain rate, and LVEF were associated with the occurrence of major adverse cardiac events, whereas only global-remained independently predictive of outcome by multivariate analysis. Conclusions-In the heart failure population, longitudinal global strain by speckle tracking is superior to LVEF and other longitudinal markers in identifying patients with poor outcome. (Circ Cardiovasc Imaging. 2010;3:249-256.)

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

“…Previous studies of LV mechanical function and clinically important outcomes in the community have predominantly focused on a single primary measure of LV strain 7, 10, 11. Our study extends previous work by investigating LV strains in different planes and concurrently examining their association with distinct CVD outcomes and mortality.…”

“…Given the need for more‐sensitive measures of LV performance, advances in image analysis have led to noninvasive methods for assessing cardiac mechanical function in multiple planes 2, 3. Numerous studies have now demonstrated that speckle tracking analyses of LV strain (ie, myocardial tissue deformation) applied to routine echocardiography offer significant incremental prognostic information over EF in patients with known cardiovascular disease (CVD) 4, 5, 6, 7, 8, 9. However, there are few studies of LV strain and outcomes in community‐dwelling individuals free of overt CVD 10, 11.…”

Prognostic Significance and Normal Values of 2D Strain to Assess Right Ventricular Systolic Function in Chronic Heart Failure

“…8, 9 Recently, 2D imaging of myocardial deformation, or strain, was found useful for assessing left ventricle (LV) function. 10 Angle-independent 2D strain imaging is now available on echocardiography systems and has been shown to reliably reflect RV function. Whether myo-…”

“…20 It is worth noting that reported RV cut-offs are higher than the previously reported LV cut-off (−9%). 10 Longitudinal motion can be quantified using either strain or strain rate. Strain rate is assumed to be load independent and superior to strain in assessing myocardial contractility and prognosis.…”

“…We previously obtained a similar result when assessing the prognostic significance of LV systolic function in patients with unstable CHF. 10 The superiority of 2D strain over strain rate may be related to the smaller amount of noise in the strain data, which facilitates identification of the peak.…”