Prognostic value of longitudinal strain of subepicardial myocardium in patients with hypertension

Lee, Wen Huang; Liu, Yen Wen; Yang, Li-Tan; Tsai, Wei Chuan

doi:10.1097/hjh.0000000000000903

Cited by 61 publications

(44 citation statements)

References 25 publications

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“…However, the results from the studies that investigated LV multilayer strain are encouraging because they demonstrate a good predictive value of LV endocardial and epicardial strain. 10,11 Our findings confirm previous results regarding deterioration of cardiac autonomic nervous system in SSc patients. [12][13][14] However, more interesting is the relationship between HRV indices and RV parameters (global strain, layer-specific strain, and 3DE ejection fraction), as well as the association between Modified Rodnan Skin Score, HRV, and RV remodeling that have not been previously studied.…”

Section: Discussionsupporting

confidence: 91%

“…Information about the predictive value of RV layer‐specific longitudinal strain is still unavailable. However, the results from the studies that investigated LV multilayer strain are encouraging because they demonstrate a good predictive value of LV endocardial and epicardial strain …”

Section: Discussionmentioning

confidence: 98%

“…New imaging techniques like speckle tracking imaging and three‐dimensional echocardiography offered an insight into cardiac function and mechanics in the SSc patients comparable with that of cardiac magnetic resonance, the “gold standard” cardiac imaging modality . Multilayer strain assessment provides comprehensive information about deformation in each myocardial layer and has a fair predictive value in patients with cardiovascular diseases . This kind of information, particularly regarding the right ventricular (RV), is still lacking in SSc patients.…”

Section: Introductionmentioning

confidence: 99%

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Systemic sclerosis impacts right heart and cardiac autonomic nervous system

Tadić

Zlatanović²,

Cuspidi

et al. 2017

J of Clinical Ultrasound

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Systemic sclerosis impacts right heart and cardiac autonomic nervous system

Tadić

Zlatanović²,

Cuspidi

et al. 2017

J of Clinical Ultrasound

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“…T he observational study of Lee et al [1] investigated the prognostic value of global longitudinal strain (GLS), subendocardial and subepicardial longitudinal strain (EndLS and EpiLS, respectively) in regularly treated hypertensive patients after a mean follow-up of 7.3 years. Using multivariate Cox regression analysis, EpiLS was the only independent predictor of events and a cut-off point value of À17.57% distinguished the worse cardiovascular outcome in the population assessed.…”

mentioning

confidence: 99%

“…The novelty of the study of Lee et al [1] corresponds to the differential prognostic value showed by EpilS and EndLS. In fact, only EpiLS stratified the prognosis, independent of the impact of confounding factors.…”

mentioning

confidence: 99%

Global longitudinal strain

Galderisi

Trimarco

2016

Journal of Hypertension

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See original paper on page 1195T he observational study of Lee et al.[1] investigated the prognostic value of global longitudinal strain (GLS), subendocardial and subepicardial longitudinal strain (EndLS and EpiLS, respectively) in regularly treated hypertensive patients after a mean follow-up of 7.3 years. Using multivariate Cox regression analysis, EpiLS was the only independent predictor of events and a cut-off point value of À17.57% distinguished the worse cardiovascular outcome in the population assessed. This is an important study, which confirms the prognostic value of GLS in the clinical setting and, particularly in the hypertensive population. Of interest, in the Coronary Artery Risk Development In young Adults study [2], among 2479 patients (average entry age ¼ 25 years), high cumulative exposure (over 25 years) to SBP and DBP was not associated with the reduction of left ventricular (LV) ejection fraction but with lower longitudinal systolic and early diastolic strain rate derived by Speckle Tracking Echocardiography. Accordingly, GLS appeared to overcome the information provided by LV hypertrophy (LVH), allowing to identify a subclinical target organ damage, which could make possible a more targeted patient's management.The prognostic power of GLS in arterial hypertension is largely supported by the physiopathologic meaning of this parameter. GLS refers mainly to LV longitudinal function of subendocardial fibers which are early involved in cardiac damage of several cardiac diseases including hypertension. Young, never treated hypertensives had lower GLS than both young sedentary controls and athletes and GLS extent was associated with the degree of E/e 0 ratio, an estimate of LV filling pressure, independent of afterload and LV mass [3]. An early GLS reduction was also found in borderline prehypertension detected by ambulatory blood pressure [4].The novelty of the study of Lee et al.[1] corresponds to the differential prognostic value showed by EpilS and EndLS. In fact, only EpiLS stratified the prognosis, independent of the impact of confounding factors. EpiLS refers mainly to the longitudinal function of subepicardial fibers, whereas previous data explored GLS itself, without analyzing differences between EpilS and EndLS. This finding extends, therefore, the importance of GLS to the need of assessing also the degree of subepicardial longitudinal dysfunction. In arterial hypertension LV subendocardial fibers appear to be negatively influenced by presence and amount of myocardial fibrosis. However, the localization of the same fibrosis has a transmural distribution [5] and a recent observation by cardiac magnetic resonance imaging highlights a prominent non-subendocardial distribution (90%) in uncomplicated hypertensive patients, the amount of fibrosis being also associated with GLS degree [6]. The increased afterload, despite influencing the overall myocardial longitudinal function, could affect in particular the LV subepicardial layer because of a preferential collagen deposition, able to entrap the...

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Myocardial Strain in the Assessment of Patients With Heart Failure

2019

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ImportanceThe cornerstones of imaging in heart failure (HF) are the measurement of systolic and diastolic function and left ventricular (LV) filling pressure.ObservationsEjection fraction and the assessment of LV filling pressure and diastolic dysfunction using the ratio of early transmitral flow and LV relaxation (E/e′) are conventional imaging markers of LV function. Despite their extensive use in HF guidelines, both have significant detractions, especially in an era when HF with preserved ejection fraction is becoming the dominant presentation. In contrast, strain imaging has provided a new window into myocardial mechanics. Myocardial strain is now well validated, robust, and can easily be performed on most modern echocardiography machines. This Review summarizes the evidence in 9 situations across the stages of HF where LV global longitudinal strain and other strain parameters may provide information on risk prediction, diagnosis, assessment of treatment response, and follow-up.Conclusions and RelevanceThe evolution of myocardial deformation imaging from research tool to clinical practice will provide clinicians with a useful additional imaging parameter to facilitate the assessment and risk evaluation of patients with HF.

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Prognostic value of longitudinal strain of subepicardial myocardium in patients with hypertension

Abstract: EpiLS was the only independent prognostic factor in regularly-treated hypertensive patients. Our results indicated that involvement of subepicardial myocardium may infer worse prognosis of hypertensive heart disease.

Cited by 61 publications

References 25 publications

Systemic sclerosis impacts right heart and cardiac autonomic nervous system

Systemic sclerosis impacts right heart and cardiac autonomic nervous system

Global longitudinal strain

Myocardial Strain in the Assessment of Patients With Heart Failure

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