Gauging global longitudinal strain may improve risk stratification in chronic HF
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Global longitudinal strain may be an effective tool for risk stratification of patients with chronic HF, according to data from the MyoVasc study published in JAMA Cardiology.
Factors such as age, sex, obesity and presence of atrial fibrillation may also be associated with global longitudinal strain, the researchers wrote.
“The findings of this study of patients with chronic HF suggest that global longitudinal strain is associated with clinical and cardiac status, reflects neurohormonal activation and is associated with cardiac mortality independent of clinical and cardiac status,” Sven-Oliver Tröbs, MD, of the department of cardiology at the University Medical Center of the Johannes Gutenberg-University Mainz in Germany, and colleagues wrote. “Thus, global longitudinal strain may serve as a useful tool to improve risk stratification in patients with HF.”
Researchers utilized data from the observational, prospective MyoVasc study to evaluate the factors associated with global longitudinal strain and its prognostic value in chronic HF. Participants with HF of stages A to D, based on American Heart Association criteria, were evaluated at a dedicated study center, and echocardiography was performed with global longitudinal strain measurement by independent reviewers. The primary outcome was all-cause and cardiac death.
Data on global longitudinal strain were available for 2,440 individuals, of whom 2,186 (mean age, 65 years; 65% men) were classified as having AHA HF stages A to D.
Factors associated with global longitudinal strain
Researchers observed that mean global longitudinal strain worsened across AHA HF stages (stage A, 19.44; stage B, 18.01; stages C and D, 15.52).
According to the study, factors independently associated with global longitudinal strain included:
- age (beta per decade = 0.27; 95% CI, 0.47 to 0.067; P = .009);
- female sex (beta per decade = 1.2; 95% CI, 1.6 to 0.77; P < .001);
- obesity (beta = 0.64; 95% CI, 0.25-1; P = .001);
- AF (beta = 1.2; 95% CI, 0.69-1.6; P < .001);
- MI (beta = 1.5; 95% CI, 1-2.1; P < .001); and
- estimated glomerular filtration rate (beta per SD = 0.53; 95% CI, 0.73 to 0.32; P < .001).
“In the present study, sex was one of the strongest clinical characteristics associated with global longitudinal strain in univariate and multivariable analyses,” the researchers wrote. “Although the underlying mechanism of global longitudinal strain is not yet fully understood, there is evidence suggesting sex-specific differences in the cardiac pathophysiologic characteristics: the proteomic response to pressure overload in mice appears to vary with sex in favor of female mice. Although male humans responded to pressure overload with chamber dilation, women developed concentric hypertrophy with an increased left ventricular ejection fraction. These outcomes might be mediated by estrogens and might also result in lower global longitudinal strain.”
All-cause and cardiac mortality
Global longitudinal strain was associated with all-cause mortality (HR per SD = 1.55; 95% CI, 1.19-2.01; P < .001) and cardiac death (HR per SD = 2.32; 95% CI, 1.57-3.42; P < .001) independent of image quality, observer variability, clinical profile, HF medications, NYHA class, and cardiac structure and function, according to the study.
Moreover, global longitudinal strain was associated with HF severity as reflected by N-terminal pro-B type natriuretic peptide levels after adjustment for cardiac structure and function (P < .001).
Further adjustment for NT-proBNP mediated risk for all-cause mortality (HR per SD = 1.26; 95% CI, 0.95-1.66; P = .11), but the relationship between global longitudinal strain and cardiac death remained significant (HR per SD = 1.6; 95% CI, 1.07-2.41; P = .02).
“Fewer data are available for the association of global longitudinal strain with cardiac death since most studies only reported a composite endpoint or did not assess cardiac death,” the researchers wrote. “In patients with HF and preserved EF, longitudinal strain (measured in the apical 4-chamber view only) was associated with an increased risk for cardiovascular death after adjustment for clinical profile and E/E ratio. However, the influence of NT-proBNP level on the association of global longitudinal strain with cardiac death was not investigated.”
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