Independent Role of Left Ventricular Global Longitudinal Strain in Predicting Prognosis of Chronic Heart Failure Patients

Iacoviello, Massimo; Puzzovivo, Agata; Guida, Pietro; Forleo, Cinzia; Monitillo, Francesco; Catanzaro, R; Lattarulo, Michele; Antoncecchi, Valeria; Favale, Stefano

doi:10.1111/echo.12142

Cited by 55 publications

(42 citation statements)

References 32 publications

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“…However, figure 3 (independent associations of all-cause mortality) shows that both studies with preserved function (Buss et al 19 and Stanton et al 6, average EF>45%), as well as most of those with impaired function (Bertini et al 11 and Sarvari et al 22, EF<45%), showed GLS to be more strongly associated than EF with outcome. Likewise, figure 5 (independent associations of composite endpoint) shows that studies by Bertini et al 11, Dahl et al 26, and Iacoviello et al 5 (EF<45%) demonstrated the hazards of impaired GLS exceed those of impaired EF, in the same way as studies showing preserved EF (Munk et al 10, Woo et al 17, average EF>45%). Thus, it appears that the risks associated with impaired GLS exceed those associated with reduced LVEF in both HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF).…”

Section: Resultsmentioning

confidence: 62%

Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction

Kalam

Otáhal

Marwick

2014

Heart

855

616

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Section: Resultsmentioning

confidence: 62%

Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction

Kalam

Otáhal

Marwick

2014

Heart

855

616

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“…Myocardial strain, assessed by speckle-tracking echocardiography, measures longitudinal myocardial shortening, 32 which predicts outcomes in patients with acute myocardial infarction, 33 heart failure, 34 and after mitral valve surgery. 35 In contrast, other investigations used thermodilution cardiac indices as the primary measure of myocardial function, 18,22,36 an approach that is limited by the fact that cardiac output does not directly reflect contractile function — which may thus explain inconsistencies in previous reports.…”

Section: Discussionmentioning

confidence: 99%

Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery

et al. 2015

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Background Glucose-insulin-potassium (GIK) administration during cardiac surgery inconsistently improves myocardial function, perhaps because hyperglycemia negates the beneficial effects of GIK. The hyperinsulinemic normoglycemic clamp (HNC) technique may better enhance the myocardial benefits of GIK. We extended previous GIK investigations by: 1) targeting normoglycemia while administering a glucose-insulin-potassium infusion (HNC); 2) using improved echocardiographic measures of myocardial deformation, specifically myocardial longitudinal strain and strain rate; and, 3) assessing activation of glucose metabolic pathways. Methods 100 patients having aortic valve replacement for aortic stenosis were randomly assigned to HNC (high-dose insulin with concomitant glucose infusion titrated to normoglycemia) versus standard therapy (insulin treatment if glucose >150 mg/dL). Our primary outcomes were left ventricular longitudinal strain and strain rate, assessed using speckle-tracking echocardiography. Right atrial tissue was analyzed for activation of glycolysis/pyruvate oxidation and alternative metabolic pathways. Results Time-weighted mean glucose concentrations were lower with HNC (127±19 mg/dL) than standard care (177±41 mg/dL; P<0.001). Echocardiographic data were adequate in 72 patients for strain analysis and 67 patients for strain rate analysis. HNC did not improve myocardial strain, with an HNC minus standard therapy difference of −1.2 (97.5%CI: −2.9, 0.5)%; P=0.11. Strain rate was significantly better, but by a clinically unimportant amount: −0.16 (−0.30, −0.03) sec−1, P = 0.007. There was no evidence of increased glycolytic, pyruvate oxidation, or hexosamine biosynthetic pathway activation in right atrial samples (n = 20, HNC; 22, standard therapy). Conclusions Administration of glucose and insulin while targeting normoglycemia during aortic valve replacement did not meaningfully improve myocardial function.

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“…Second, patients with low LVEF (<50%) and/or HF were not enrolled in the current study, which limits the generalizability of our findings to a general hemodialysis population. However, the serum cTnT concentration [54–56] and GLS [57–59] were predictive of the prognosis in nondialysis acute and chronic HF patients with varying LVEF values. Whether the measurement of cTnT concentrations or GLS or the combination thereof is also useful for risk stratification in a general hemodialysis population including patients with low LVEF and/or HF warrants further studies.…”

Section: Discussionmentioning

confidence: 99%

Independent Value of Cardiac Troponin T and Left Ventricular Global Longitudinal Strain in Predicting All-Cause Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Sung

Chang

et al. 2014

BioMed Research International

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Using a speckle-tracking echocardiography (STE), we recently demonstrated that a left ventricular (LV) global longitudinal strain (GLS) ≥ −15% and the serum cardiac troponin T (cTnT) concentration are associated with mortality in stable hemodialysis patients with preserved LV ejection fraction (LVEF). In this study, we explored the relationship between cTnT and echocardiographic parameters and evaluated whether the prognostic value provided by cTnT is independent of a GLS ≥ −15% and vice versa. Eighty-eight stable hemodialysis patients with preserved LVEF were followed for 31 months. STE studies and measurements of cTnT were performed at baseline. CTnT concentration had a modest correlation with GLS (r s = 0.44; P < 0.001) but had a weak or nonsignificant correlation with other echocardiographic parameters. Adjusting for clinical parameters, hazard ratios for each increase of 0.01 ng/mL in cTnT, and a GLS ≥ −15% on mortality were 1.13 (P = 0.009) and 3.09 (P = 0.03) without significant interaction between cTnT and GLS ≥ −15%. In addition, an increased cTnT concentration, a GLS ≥ −15%, or their combination showed significant additional predictive value for mortality when included in models consisting of clinical parameters. Therefore, both cTnT and a GLS ≥ −15% are independent predictors of mortality and are useful for risk stratification.

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Independent Role of Left Ventricular Global Longitudinal Strain in Predicting Prognosis of Chronic Heart Failure Patients

Abstract: Quantifying LV longitudinal systolic function in CHF outpatients on the basis of 2D speckle tracking analysis provides a new parameter that independently predicts patient outcome, thus, strengthening its possible role in current clinical practice.

Cited by 55 publications

References 32 publications

Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction

Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction

Hyperinsulinemic Normoglycemia Does Not Meaningfully Improve Myocardial Performance during Cardiac Surgery

Independent Value of Cardiac Troponin T and Left Ventricular Global Longitudinal Strain in Predicting All-Cause Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

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