Abstract Objectives The purpose of this study was to investigate the prognostic value of global longitudinal strain (GLS) in heart failure with reduced ejection fraction (HFrEF) patients in relation ...to all-cause mortality. Background Measurement of myocardial deformation by 2-dimensional speckle tracking echocardiography, specifically GLS, may be superior to conventional echocardiographic parameters, including left ventricular ejection fraction, in predicting all-cause mortality in HFrEF patients. Methods Transthoracic echocardiographic examinations were retrieved for 1,065 HFrEF patients admitted to a heart failure clinic. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained. Results Many of the conventional echocardiographic parameters proved to be predictors of mortality. However, GLS remained an independent predictor of mortality in the multivariable model after adjusting for age, sex, body mass index, total cholesterol, mean arterial pressure, heart rate, ischemic cardiomyopathy, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, noninsulin dependent diabetes mellitus, and conventional echocardiographic parameters (hazard ratio HR: 1.15; 95% confidence interval CI: 1.04 to 1.27; p = 0.008, per 1% decrease). No other echocardiographic parameter remained an independent predictor after adjusting for these variables. Furthermore, GLS had the highest C-statistics of all the echocardiographic parameters and added incremental prognostic value with a significant increase in the net reclassification improvement (p = 0.009). Atrial fibrillation (AF) modified the relationship between GLS and mortality (p value for interaction = 0.036); HR: 1.08 (95% CI: 0.97 to 1.19), p = 0.150 and HR: 1.22 (95% CI: 1.15 to 1.29), p < 0.001, per 1% decrease in GLS for patients with and without AF, respectively. Sex also modified the relationship between GLS and mortality (p value for interaction = 0.047); HR: 1.23 (95% CI: 1.16 to 1.30), p < 0.001 and HR: 1.09 (95% CI: 0.99 to 1.20), p = 0.083, per 1% decrease in GLS for men and women, respectively. Conclusions GLS is an independent predictor of all-cause mortality in HFrEF patients, especially in male patients without AF. Furthermore, GLS was a superior prognosticator compared with all other echocardiographic parameters.
Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and ...mortality in the general population is unknown.
A total of 1296 participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death. During a median follow-up of 11 years, 149 (12%) participants were diagnosed with heart failure, acute myocardial infarction, or cardiovascular death. Lower GLS was associated with a higher risk of the composite end point (hazard ratio, 1.12; 95% confidence interval, 1.08-1.17;
<0.001 per 1% decrease), an association that persisted after multivariable adjustment for age, sex, heart rate, hypertension, systolic blood pressure, left ventricular ejection fraction, left ventricular mass index, left ventricular dimension, deceleration time, left atrium dimension,
/
', and pro B-type natriuretic peptide (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11;
=0.045 per 1% decrease). GLS provided incremental prognostic information beyond the Framingham Risk Score, the Systemic Coronary Evaluation risk chart, and the modified American College of Cardiology/American Heart Association Pooled Cohort Equation for the composite outcome and incident heart failure. Sex modified the relationship between GLS and outcome such that after multivariable adjustment, GLS was an independent predictor of outcomes in men but not in women (hazard ratio, 1.14; 95% confidence interval, 1.06-1.24;
=0.001, and hazard ratio, 0.99; 95% confidence interval, 0.92-1.07;
=0.81, respectively;
for interaction =0.032).
In the general population, GLS provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality. GLS seems to be a stronger prognosticator in men than in women.
Aims
To investigate the association between measures of peripheral neuropathy (PN) and impaired left ventricular diastolic function, and the prognosis in patients with type 1 diabetes (T1DM) and no ...known cardiovascular disease (CVD), and to test the incremental prognostic value of including measures of PN and diastolic function to the established Steno T1 Risk Engine.
Methods
Echocardiography and quantitative biothesiometry was performed to evaluate diastolic function and PN. The participants were categorized according to severity of diastolic function and PN. The study endpoint was combined cardiovascular (CV) events and all‐cause death. Associations were analysed using multivariable regression models. The prognostic capability was assessed with Harrell's C‐statistics and tested against the Steno T1 Risk Engine.
Results
A total of 946 individuals (51.5% men) were included. The mean (SD) follow‐up was 6 (1.3) years. The total number of CV events and all‐cause death were 100. In the multi‐adjusted analysis, both PN and impaired diastolic function were associated with increased risk of CV events and all‐cause death: severe PN versus no PN: hazard ratio (HR) 2.23 (95% confidence interval CI 1.06–4.68; P = 0.035); severe diastolic impairment versus normal function: HR 2.27 (95% CI 1.16–4.44; P = 0.016).
Measures of diastolic function improved prognostic capability when added to the Steno T1 Risk Engine: C‐statistic 0.797 (95% CI 0.793–0.817) versus 0.785 (95% CI 0.744–0.825; P = 0.006).
Conclusion
Peripheral neuropathy and impaired diastolic function are associated with an increased risk of CV events and all‐cause death in patients with T1DM. Measures of diastolic function improved prediction of prognosis by the Steno T1 Risk Engine.
Identifying clinical and echocardiographic parameters associated with improvement in systolic function in outpatients with heart failure with reduced ejection fraction (HFrEF) could lead to more ...targeted treatment improving systolic function and outcome.
In a retrospective cohort study, echocardiographic examinations from the first and final visit of 686 patients with HFrEF at the heart failure clinic at Gentofte Hospital were retrieved and analysed. Parameters associated with left ventricular ejection fraction (LVEF) improvement and survival according to LVEF improvement were assessed using linear regression and Cox regression, respectively. Beta-coefficients (β-coef) are standardised. Strain values are absolute.
While undergoing heart failure treatment, 559 (81.5%) patients improved systolic function ( Δ LVEF >0%), with 100 (14.6%) being super responders defined by LVEF improvement >20%. After multivariable adjustment, LVEF improvement was significantly associated with a less impaired global longitudinal strain (β-coef 0.25, p<0.001), higher tricuspid annular plane systolic excursion (β-coef 0.09, p=0.018), smaller left ventricular internal dimension in diastole (β-coef -0.15, p=0.011), lower E-wave/A-wave ratio (β-coef -0.13, p=0.003), higher heart rate (β-coef 0.18, p<0.001) and absence of ischaemic cardiomyopathy (β-coef -0.11, p=0.010) and diabetes (β-coef -0.081, p=0.033) at baseline. Mortality incidence rates differed with LVEF improvement ( Δ LVEF <0% vs Δ LVEF >0%, 8.3 vs 4.3 per 100 person years, p=0.012). Greater improvement in LVEF was associated with significantly lower mortality risk (tertile 1 vs tertile 3, HR 3.23, 95% CI 1.39 to 7.51, p=0.006).
In this outpatient HFrEF cohort, most patients improved systolic function. Heart failure aetiology, comorbidities and echocardiographic measures of heart structure and function were significantly, independently associated with future LVEF improvement. Greater LVEF improvement was significantly associated with lower mortality.
Background
Previous studies have identified several echocardiographic markers of cardiac dysfunction in participants with diabetes mellitus, including E/e’. However, previous studies have been ...limited by short follow‐up duration or low statistical power, and none have assessed whether echocardiographic predictors of adverse cardiovascular outcome differ between individuals with DM and individuals without DM.
Methods
A total of 1997 individuals from the general population without heart disease had an echocardiogram performed in 2001 to 2003. Diabetes was defined as HbA1c ≥6.5% (≥48 mmol/mol), non‐fasted blood glucose ≥11.1 mmol/L or the use of glucose lowering medication. The end‐point was a composite of heart failure (HF), ischemic heart disease (IHD) and cardiovascular death (CVD).
Results
At baseline, a total of 292 participants (15%) had diabetes. Median follow‐up time was 12.4 years (interquartile‐range: 9.8–12.8 years) and follow‐up was 100%. During follow‐up, 101 participants (35%) with diabetes and 281 participants without diabetes (16%) reached the composite end‐point. The prognostic value of E/e’ was significantly modified by diabetes (p for interaction: 0.003). In participants with diabetes, only E/e’ remained an independent predictor of outcome in a final multivariable model adjusted for clinical and echocardiographic parameters (HR 1.08, 95% CI 1.00–1.17, p = 0.0041, per 1 increase). In participants without diabetes, left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF) and a’ remained independent predictors of outcome when adjusted for clinical and echocardiographic parameters. In individuals with diabetes, only E/e’ added incremental prognostic value to risk factors from the SCORE risk chart and the ACC/AHA Pooled Cohort Equation.
Conclusion
In individuals with diabetes from the general population, E/e’ is a stronger predictor of cardiovascular mortality and morbidity than in individuals without diabetes and contributes with incremental prognostic value in addition to established cardiovascular risk factors.
Twenty-five percent of ischemic strokes (IS) are cryptogenic, but it is estimated that paroxysmal atrial fibrillation (PAF) is the underlying cause in up to a third of cases. We aimed to investigate ...the predictive value of speckle tracking of the left atrium (LA) in diagnosing PAF in IS patients. We retrospectively studied 186 IS patients with a clinical echocardiographic examination during sinus rhythm. Outcome was PAF defined by at least one reported episode of AF following their IS. Conventional echocardiographic measures were performed. Global longitudinal strain (GLS), LA reservoir-(ε
s
), conduit-(ε
e
), contraction-strain (ε
a
) and LA dyssynchrony (standard deviation of time-to-peak ε
s
; LA SD-T2P) were obtained by left ventricular and LA speckle tracking. Of 186 patients, 28 (15%) were diagnosed with PAF. PAF-patients did not differ from non-PAF patients with regards to GLS nor SD-TPS, but atrial strain measures were significantly impaired at baseline (ε
s
27 vs. 35%, ε
e
12 vs. 16%, ε
a
15 vs. 18%, p < 0.02 for all, for PAF and non-PAF, respectively). However, only ε
s
remained independently associated with PAF after adjustment for clinical and echocardiographic parameters (OR 1.13 1.04; 1.22, p = 0.003, per 1% decrease). ε
s
also provided the highest area under the receiver operating characteristic curve among all variables (AUC = 0.74). With a cutoff of 29%, ε
s
had a specificity of 76% and a negative predictive value of 93%. Atrial reservoir strain is independently associated with PAF and may be used to improve the diagnosis of PAF following IS.
In studies on left-sided valve disease, patients with combined lesions are generally excluded. We aimed to describe the clinical management and prognosis of patients with combined left-sided valve ...disease.From a single, tertiary care center, a total of 122 patients with combined left-sided valve disease of at least moderate severity were identified and compared with 143 controls with single-lesion valve disease (1VaD) of at least moderate severity. Endpoints were all-cause mortality and the combination of valve intervention and mortality.Overall survival for patients with two-lesion valve disease was significantly lower than that for patients with 1VaD (estimated 3-year survival: 52% versus 73%, P < 0.001). Compared with 1VaD, the combination of aortic stenosis and aortic regurgitation (AS/AR) was associated with a similar overall survival (hazard ratio (HR) (95% confidence interval (CI) ): 0.83 (0.47-1.48), P = 0.53), the combination of AR and mitral regurgitation (AR/MR) with an intermediate survival (HR (95% CI): 1.76 (1.03-3.00), P = 0.039) and the combination of AS and MR (AS/MR) with the poorest survival (HR (95% CI): 3.28 (2.16-4.98), P < 0.001). At 2.2 years of follow-up, the majority of patients in all three groups were either dead or had received valve intervention (AS/AR: 72%, AR/MR: 64%, and AS/MR: 80%).Combined valve disease was relatively rare but was associated with a decreased overall survival. Survival depended on the specific combination of valve lesions, with AS/MR carrying the worst prognosis. The majority of patients in all groups were either dead or had valve intervention performed within 2.2 years.
To investigate the prognostic value of layer-specific global longitudinal strain (GLS) in predicting heart failure (HF) and cardiovascular death (CD) following acute coronary syndrome (ACS).
In this ...retrospective study, 465 ACS patients underwent transthoracic echocardiography following percutaneous coronary intervention (PCI). The primary endpoint was the composite of HF and/or CD with a median follow-up time of 4.6 (0.2-6.3) years. During follow-up 199 patients (42.7%) suffered HF and/or CD (176 developed HF and 38 suffered CD). Absolute endomyocardial global longitudinal strain (GLSendo) (12% vs. 17%, P < 0.001), GLS (11% vs. 14%, P < 0.001), and epimyocardial global longitudinal strain (GLSepi) (9% vs. 13%, P < 0.001) were all reduced in patients with an adverse outcome. In multivariable Cox regressions, which included clinical baseline characteristics and conventional echocardiographic measurements, GLS obtained from all layers remained independently associated with the composite outcome; GLSendo hazard ratio: 1.19 (1.10-1.28), P < 0.001, per 1% decrease, GLS hazard ratio 1.24 (1.14-1.35), P < 0.001, per 1% decrease, and GLSepi hazard ratio 1.26 (1.15-1.39), P < 0.001, per 1% decrease. No other echocardiographic measures remained independently associated with the composite outcome in these models. Finally, GLS and GLSepi provided incremental prognostic information on the risk of developing the composite endpoint, when added to all other clinical and echocardiographic measures adding GLS (c-statistics: 0.76 vs. 0.74, P = 0.048) or adding GLSepi (c-statistics: 0.76 vs. 0.74, P = 0.039).
In ACS patients, layer-specific strain provides independent prognostic information regarding risk of developing HF and/or CD. Furthermore, only GLS and GLSepi provided incremental prognostic information when added to all other significant predictors.
Elderly individuals occupy an increasing part of the general population. Conventional and speckle-tracking transthoracic echocardiography may help guide risk stratification in these individuals. The ...purpose of this study was to evaluate the potential utility of conventional and speckle-tracking echocardiography in the screening of cardiac abnormalities in the elderly population.
Two cohorts of elderly individuals (sample size: 1441 and 944) were analyzed, who were part of a randomized controlled clinical trial (LOOP study) and of an observational study (Copenhagen City Heart Study), recruiting participants from the general population >70 years of age with cardiovascular risk factors (arterial hypertension, diabetes mellitus, heart failure, or prior stroke) and sinus rhythm. Participants underwent a comprehensive transthoracic echocardiographic examination, including myocardial speckle tracking. Cardiac abnormalities were defined according to the ASE/EACVI guidelines.
Structural cardiac abnormalities such as left ventricular (LV) remodeling, mitral annular calcification (MAC), and aortic valve sclerosis (with or without stenosis) were highly prevalent in the LOOP study (40%, 39%, and 27%, respectively). Moreover, a high prevalence of functional cardiac alterations such as LV diastolic dysfunction (LVDD), abnormal LV longitudinal systolic strain (GLS), and abnormal left atrial (LA) reservoir strain was present in the LOOP study (27%, 18%, and 9%, respectively). Likewise, the rate of LVDD, abnormal GLS, and abnormal LA reservoir strain was comparable in the validation sample from the Copenhagen City Heart Study. In line with these findings, subjects with LV remodeling, MAC, and aortic valve changes had a higher prevalence of LVDD, abnormal GLS, and abnormal LA reservoir strain than those without structural cardiac alterations.
The findings of this study highlight the potential clinical utility of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in the elderly population. Further studies are warranted to determine the prognostic relevance of these findings.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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