Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community‐based cohort

Abstract

Aims Global longitudinal strain (GLS) assessed by speckle-tracking echocardiography has been proposed as a parameter able to reflect early changes in left ventricular (LV) systolic function at a stage when LV ejection fraction (LVEF) is still normal. This study aimed at assessing prevalence and prognostic value of LV systolic dysfunction (LVSD) assessed by echocardiographic speckle-tracking GLS in a community-based cohort. Methods and Results Participants from the community-based prospective Northern Manhattan Study underwent 2-dimensional transthoracic echocardiography as part of the Cardiovascular Abnormalities and Brain Lesions study. LV systolic function was assessed by LVEF and speckle-tracking GLS. Subjects were followed annually (mean=4.8±1.5 years) and incident vascular events (ischemic stroke, myocardial infarction, and vascular death) were reviewed and adjudicated. Of the 708 study participants, 114 (16.1%) had abnormal GLS but normal LVEF (GLS-LVSD), 30 (4.2%) had abnormal LVEF (LVEF-LVSD), and 564 (79.7%) had normal GLS and LVEF (no-LVSD). In multivariate analysis, risk of events was significantly greater in GLS-LVSD [adjusted hazard ratio (HR)=2.39, 95% confidence intervals (CI)=1.20–4.77] and in LVEF-LVSD (adjusted HR=3.51, 95% CI=1.25–9.88) compared to no-LVSD. Among participants with normal LVEF, lower GLS was significantly associated with events (adjusted HR/unit decrease=1.15, 95% CI=1.03–1.28) whereas LVEF was not (adjusted HR/unit decrease=1.01, 95% CI=0.94–1.07). GLS prognostic value was incremental to risk factors and LVEF both in the overall population (chi-square change=7.406, p=0.006) and in participants with normal LVEF (chi-square change=6.357, p=0.012). Conclusion In a community-based cohort, GLS-LVSD was four times more frequent than LVEF-LVSD. GLS-LVSD was a powerful and independent predictor of cardiovascular events. LV function assessment by GLS may improve cardiovascular risk stratification in subjects with normal LVEF.

Assessing Contractile Function When Ejection Fraction Is Normal

“…In patients with low LVEF, both GLS and LVEF were capable in identifying patients in high risk of mortality, but in the high LVEF spectra, fatal events were distributed across a wide range of LVEFs, whereas almost all deceased patients had GLS<15%, despite relatively preserved LVEF. 15 Besides being the largest prospective study assessing the usefulness of GLS to predict outcome in patients with sepsis, the authors also display, like other reports have done previously, 3,4,6 that GLS especially seems to provide incremental information about outcomes in the setting of a preserved LV systolic function as assessed by LVEF. Therefore, when LVEF is low, all cardiologist are well aware that the patient is at high risk, however, when LVEF is preserved, we need additional and other information about cardiac function, and GLS might be the clinical tool to use.…”

“…14 Recent studies have demonstrated that a impaired myocardial deformation, as assessed by low GLS, seems to provide incremental prognostic information to LVEF about the risk of cardiovascular morbidity and mortality, especially when LVEF is relatively preserved. 3,4,6 Similar results are presented in the current issue of Circulation: Cardiovascular Imaging, where Palmieri et al 15 report an interesting article, which aims to investigate whether GLS provide incremental prognostic information in patients admitted to a subintensive medical unit with severe sepsis or septic shock. 15 This prospective study included 115 patients admitted to a single subintensive medical unit, who had an echocardiogram performed within 24 hours of admission.…”

Determining Preclinical Left Ventricular Function Impairment with Two-Dimensional Speckle Tracking Echocardiography in Patients with Psoriasis Vulgaris

“…Yapılan çalışmalarda GLS'nin kardiyovasküler olaylar için sol vetrikül EF'den bağımsız ve güçlü bir prediktör olduğu gösterilmiştir (33)(34)(35) . Bu nedenle, Biz bu çalışmamızda PV hastalarında konvansiyonel yöntemlerle yapılan ölçümlerde sol ventrikül fonksiyonları korunmuş olsa dahi STE yöntemi ile yapılan ölçümlerde tespit edilen miyokardiyal bozulmanın, sol ventrikül üzerinde remodelinge yol açacağı bununda uzun dö-nemde PV hastalarında kardiyovasküler morbidite ve mortaliteyi artırabileceği düşüncesindeyiz.…”

What are the benefits of two-dimensional speckle tracking echocardiography for diagnosis and treatment follow-up of childhood-onset systemic lupus erythematosus myocarditis?

“…6,7 2DST deformation analysis has also been proven as a valuable echocardiographic tool for detection of subclinical myocardial compromise in a wide range of diseases, with undoubted prognostic and therapeutic implications. 8 Although negative correlation between SLEDAI-2K and LV longitudinal peak systolic strain has already been documented by transversal studies in c-SLE patients with no signs or symptoms of heart failure, 7 no prospective study has ever documented LV myocardial deformation pattern of patients throughout as well as in-between flares.…”