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Global longitudinal strain predicts mortality in acute HF
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Global longitudinal strain more accurately predicted mortality than left ventricular ejection fraction among patients with acute HF, researchers reported.
Global longitudinal strain “has greater prognostic value than LVEF. Therefore, we suggest [global longitudinal strain] should be considered as the standard measurement in all patients with HF,” Jin Joo Park, MD, PhD, from the department of internal medicine at Seoul National University Bundang Hospital in Seongnam, South Korea, and colleagues wrote.
Park and colleagues measured global longitudinal strain in 4,172 patients with acute HF. Patients were classified as having HF with reduced EF (< 40%), midrange HF (40%-49%) and preserved EF ( 50%).
Mildly reduced strain was defined as global longitudinal strain of at least 12.6%, moderately reduced strain was defined as global longitudinal strain between 8.1% and 12.5%, and severely reduced strain was defined as global longitudinal strain 8% or less.
The primary endpoint was all-cause mortality at 5 years.
Mean LVEF was 40%, mean global longitudinal strain was 10.8% and 40.4% of patients died at 5 years, Park and colleagues reported.
Patients with reduced EF had a 41% mortality rate vs. 38% of those with midrange EF and 39% of those with preserved EF (log-rank P = .031), according to the researchers.
However, there was a more significant difference in 5-year mortality by global longitudinal strain category (severe group, 49%; moderate group, 38%; mild group, 34%; log-rank P < .001), Park and colleagues wrote.
When the researchers performed a multivariable analysis, they found that each 1% increase in global longitudinal strain was associated with a 5% reduced risk for mortality (P < .001).
Compared with the mildly reduced strain group, the severely reduced strain group had greater mortality (HR = 1.61; 95% CI, 1.36-1.91), as did the moderately reduced strain group (HR = 1.31; 95% CI, 1.13-1.53), but mortality risk did not vary by LVEF category, according to the researchers.
In a related editorial, Kristina H. Haugaa, MD, PhD, and Lars A. Dejgaard, MD, both from the Center for Cardiological Innovation and department of cardiology at Oslo University Hospital in Norway, wrote: “Using both [global longitudinal strain] and EF for assessing systolic function, several studies have now revealed that [global longitudinal strain] may be reduced, although EF is still preserved. Therefore, it is essential to differentiate between the terms systolic function and EF, which are not synonymous and not interchangeable. In hearts with mildly reduced function, EF is not sensitive enough to detect dysfunction.
“If the medical community has ignored previous reports about the prognostic value of [global longitudinal strain], this paper should help convince those who are still in doubt,” Haugaa and Dejgaard wrote. – by Erik Swain
Disclosures: The authors, Dejgaard and Haugaa report no relevant financial disclosures.
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