Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure

• Published in: Journal of the American College of Cardiology Vol. 54; no. 7; pp. 618 - 624
• Main Authors: Cho, Goo-Yeong, Marwick, Thomas H., Kim, Hyun-Sook, Kim, Min-Kyu, Hong, Kyung-Soon, Oh, Dong-Jin
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 11.08.2009; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Confidence intervals; congestive heart failure; Drug therapy; Echocardiography, Doppler - methods; Enzymes; Female; Heart; Heart attacks; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Function Tests - methods; Heart Ventricles - diagnostic imaging; Humans; Internal Medicine; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Myocardial Contraction - physiology; Patients; Prognosis; Proportional Hazards Models; ROC Curve; Statistical analysis; strain; Stroke Volume; Studies; Variables; ventricular function; Ventricular Function, Left; strain; EF; CI; ventricular function; ROC; LVEF; HR; LV; prognosis; GLS; 2D; GCS; congestive heart failure; E/e; ratio of early transmitral flow to early diastolic annular velocity; ejection fraction; global circumferential strain; left ventricular ejection fraction; global longitudinal strain; 2-dimensional; receiver-operating characteristic; hazard ratio; confidence interval; left ventricle/ventricular; Case study; Human; Heart failure; Heart disease; Cardiovascular disease; Circulatory system; Cardiology; Strain
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2009.04.061

We sought to evaluate whether global 2-dimensional (2D) strain offers additional benefit over left ventricular ejection fraction (LVEF) to predict clinical events in heart failure. Although 2D strain based on speckle tracking has been proposed as a simple and reproducible tool to detect systolic dysfunction, the relationship of 2D strain and prognosis has not been studied. Two hundred one patients (age 63 ± 11 years, 34% female, LVEF 34 ± 13%) hospitalized for acute heart failure underwent clinical evaluation and conventional and tissue Doppler echocardiography. Using dedicated software, we measured the global longitudinal strain (GLS) in apical 4- and 2-chamber views and the global circumferential strain (GCS) in a parasternal short-axis view. Cardiac events were defined as readmission for heart failure or cardiac death. There were 23.4% clinical events during 39 ± 17 months of follow-up. In univariate analysis, age, left atrial volume, left ventricular volume, LVEF, ratio of early transmitral flow to early diastolic annular velocity (E/e′), and both GLS and GCS were predictive of cardiac events. In multivariate Cox models, age (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.10, p = 0.017) and GCS (HR: 1.15, 95% CI: 1.04 to 1.28; p = 0.006) were independently associated with cardiac events. By Cox proportional hazards model, the addition of GCS markedly improved the prognostic utility of a model containing ejection fraction, E/e′, and GLS. GCS is a powerful predictor of cardiac events and appears to be a better parameter than ejection fraction in patients with acute heart failure.