Incremental value of global longitudinal strain for predicting early outcome after cardiac surgery

Ternacle, Julien; Berry, Matthieu; Alonso, Enrique Ruiz; Martin, Kathleen A.; Couëtil, Jean‐Paul; Randé, Jean-Luc Dubois; Guéret, Pascal; Monin, Jean‐Luc; Lim, Pascal

doi:10.1093/ehjci/jes156

Cited by 83 publications

(60 citation statements)

References 20 publications

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“…A previous study reported an association between impaired LV-GLS and mortality; however, only 23% of these patients underwent MV surgery. 24 Another study using rest and stress echocardiography reported a higher event rate (death, MV surgery, and heart failure admissions) in patients with an abnormal GLS contractile reserve. 25 The current study had a significantly larger sample size and a much longer follow-up with a hard end point of mortality, along with studying the sequentially incremental impact of LV-GLS and BNP.…”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20][21][22][23] However, prognostic data regarding the role of LV-GLS in MR patients is sparse. 24,25 Furthermore, to the best of our knowledge, the potential additive value of BNP and LV-GLS in risk stratification of patients with significant MR who underwent MV surgery has not been previously studied. In a contemporary population of asymptomatic patients with significant MR and preserved LVEF who underwent MV surgery, we sought to determine whether baseline LV-GLS and BNP (1) were associated with a reduction in postoperative LVEF and (2) provided incremental prognostic utility over conventional measures previously shown to affect outcome in this condition.…”

mentioning

confidence: 99%

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Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery

Alashi

Mentias

Patel

et al. 2016

Circ: Cardiovascular Imaging

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I n the developed world, myxomatous degeneration of the mitral valve (MV) is the most common cause of mitral regurgitation (MR).1,2 Surgical correction remains the cornerstone of management in severe primary MR because medical management alone does not improve the hemodynamic consequences of the regurgitant valve and its impact on outcome. 3,4 According to the most recent guidelines, indications for surgical intervention in patients with severe primary MR are development of symptoms, asymptomatic left ventricular (LV) systolic dysfunction, new-onset AF, or pulmonary arterial hypertension.5 However, appropriate timing of surgical intervention in asymptomatic severe primary MR is often challenging. Advances in MV repair have led to excellent long-term results with low morbidity and mortality at experienced centers 6,7 such that the threshold to recommend surgical intervention at these centers has been lowered by the guidelines when Background-In asymptomatic patients with ≥3+ mitral regurgitation and preserved left ventricular (LV) ejection fraction who underwent mitral valve surgery, we sought to discover whether baseline LV global longitudinal strain (LV-GLS) and brain natriuretic peptide provided incremental prognostic utility. Methods and Results-Four hundred and forty-eight asymptomatic patients (61±12 years and 69% men) with ≥3+ primary mitral regurgitation and preserved left ventricular ejection fraction, who underwent mitral valve surgery (92% repair) at our center between 2005 and 2008, were studied. Baseline clinical and echocardiographic data (including LV-GLS using Velocity Vector Imaging, Siemens, PA) were recorded. The Society of Thoracic Surgeons score was calculated. The primary outcome was death. Mean Society of Thoracic Surgeons score, left ventricular ejection fraction, mitral effective regurgitant orifice, indexed LV end-diastolic volume, and right ventricular systolic pressure were 4±1%, 62±3%, 0.55±0.2 cm 2 , 58±13 cc/m 2 , and 37±15 mm Hg, respectively. Forty-five percent of patients had flail. Median log-transformed BNP and LV-GLS were 4.04 (absolute brain natriuretic peptide: 60 pg/dL) and −20.7%. At 7.7±2 years, death occurred in 41 patients (9%; 0% at 30 days). On Cox analysis, a higher Society of Thoracic Surgeons score (hazard ratio 1.55), higher baseline right ventricular systolic pressure (hazard ratio 1.11), more abnormal LV-GLS (hazard ratio 1.17), and higher median log-transformed BNP (hazard ratio 2.26) were associated with worse longer-term survival (all P<0.01). Addition of LV-GLS and median log-transformed BNP to a clinical model (Society of Thoracic Surgeons score and baseline right ventricular systolic pressure) provided incremental prognostic utility (χ 2 for longer-term mortality increased from 31-47 to 61; P<0.001). Conclusions-In asymptomatic patients with significant primary mitral regurgitation and preserved left ventricular ejection fraction who underwent mitral valve surgery, brain natriuretic peptide and LV-GLS provided synergistic risk stratification, independent o...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery

Alashi

Mentias

Patel

et al. 2016

Circ: Cardiovascular Imaging

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“…This was further confirmed in a prospective study of 425 patients referred for cardiac surgery. 9 This study demonstrated that GLS was an independent predictor, superior to EF, for early postoperative mortality after adjustment to EuroSCORE. In an era of multimodality imaging, it is important to know how values compare between imaging modalities.…”

Section: Myocardial Functionmentioning

confidence: 57%

The year 2012 in the European Heart Journal - Cardiovascular Imaging: Part I

Edvardsen

Plein

Saraste

et al. 2013

European Heart Journal - Cardiovascular Imaging

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The new multimodality cardiovascular imaging journal, European Heart Journal -Cardiovascular Imaging, was created in 2012. Here, we summarize the most important studies from the journal's second year in two articles. Part I of the review will focus on studies in myocardial function, myocardial ischaemia, and emerging techniques in cardiovascular imaging, and Part II will focus on valvular heart diseases, heart failure, cardiomyopathies, and congenital heart diseases.--

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“…19 Despite similar surgical risk EuroSCORE, the postoperative death rate was significantly higher and 2.4-fold increased in patients with abnormal global longitudinal strain even in preserved ejection fraction. 20 Long isovolumic time (odds ratio 1.37, P = 0.035) predicts adverse cardiac events after CABG. 21 We observed similar EuroSCORE in both good and poor outcome groups.…”

Section: Discussion-mentioning

confidence: 98%

Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting

Jha

Malik

Gharde

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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Incremental value of global longitudinal strain for predicting early outcome after cardiac surgery

Abstract: GLS has an incremental value over LVEF for risk stratification in patients referred for cardiac surgery.

Cited by 83 publications

References 20 publications

Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery

Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery

The year 2012 in the European Heart Journal - Cardiovascular Imaging: Part I

Echocardiographic Predictors of Immediate Postoperative Outcomes in Patients With Severe Left Ventricular Systolic Dysfunction Undergoing On-Pump Coronary Artery Bypass Grafting

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