Global longitudinal strain as a potential prognostic marker in patients with chronic heart failure and systolic
Inês Rangel1, Alexandra Gonçalves2, Carla de Sousa1
1Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.
Insights
Left ventricular global longitudinal strain (GLS) effectively measures chronic heart failure severity and predicts reduced life expectancy in patients with systolic dysfunction.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Prognostic value of myocardium deformation in chronic heart failure (CHF) is understudied.
- Left ventricular (LV) global longitudinal strain (GLS) is a key measure of myocardial function.
Purpose of the Study:
- To evaluate the correlation of LV global longitudinal strain (GLS) with clinical and prognostic indicators in CHF patients.
- To assess GLS as a predictor of life expectancy in systolic heart failure.
Main Methods:
- Echocardiographic assessment of GLS in ambulatory CHF patients with LV ejection fraction <45%.
- Correlation analysis with clinical parameters (NYHA class, BNP, LVEF, E/e' ratio, LV end-diastolic pressure, left atrial volume index).
- Prognostic status evaluated using the Seattle Heart Failure Model (SHFM).
Main Results:
- GLS correlated significantly with NYHA class, BNP, LVEF, E/e' ratio, and left atrial volume index.
- GLS showed a significant correlation with SHFM prognostic estimates for life expectancy (r=-0.41, p=0.002).
- GLS independently predicted an estimated life expectancy <10 years (OR 2.614), with an ROC AUC of 0.802.
Conclusions:
- GLS is strongly associated with increased chronic heart failure severity.
- GLS serves as an independent predictor of reduced life expectancy in CHF patients.
Introduction And Objective:
The prognostic value of myocardium deformation measurements in chronic heart failure (CHF) is still poorly addressed. The purpose of this study was to evaluate the correlation of left ventricular (LV) global longitudinal strain (GLS) with clinical and prognostic indicators in patients with CHF and systolic dysfunction.
Methods:
Ambulatory patients with CHF and LV ejection fraction (LVEF) <45% were studied by two-dimensional and Doppler transthoracic echocardiogram with assessment of GLS. An indication of prognostic status was obtained by the Seattle Heart Failure Model (SHFM) prognostic estimates for life expectancy.
Results:
We included 54 CHF patients (mean age 55±12 years; 80% male). GLS was significantly correlated with NYHA functional class (r=0.41, p=0.002), BNP levels (r=0.47, p=0.001), LVEF (r=-0.69, p<0.001) and LV end-diastolic pressure, assessed by E/e' ratio (r=0.35, p<0.014) and left atrial maximal volume index (r=0.57, p<0.001). A significant correlation was found between GLS and SHFM prognostic estimates for life expectancy (r=-0.41, p=0.002). The multivariate logistic regression analysis showed that GLS independently predicted an estimated life expectancy <10 years (OR 2.614 [95% CI 1.010-6.763]). The corresponding area under the ROC curve was 0.802 (0.653-0.951) and the best obtained threshold was -9.5 (80% sensitivity, 65% specificity, p=0.003).
Conclusions:
GLS was strongly associated with a higher disease severity status and predicted a lower prognostic estimate for life expectancy.
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