Prognostic Implications of LV Strain Risk Score in Asymptomatic Patients With Hypertensive Heart Disease
Makoto Saito1, Faisal Khan2, Ted Stoklosa2
1Menzies Institute for Medical Research, Hobart, Australia.
Insights
Left ventricular strain and its changes predict major adverse cardiac events in hypertensive heart disease. A new risk score including strain improves MACE prediction.
Area of Science:
- Cardiology
- Echocardiography
- Hypertensive Heart Disease
Background:
- Hypertensive heart disease is linked to adverse cardiac events, often associated with abnormal left ventricular (LV) morphology.
- The role of subclinical LV dysfunction, specifically LV strain, in predicting these events remains unclear.
Purpose of the Study:
- To investigate the association of left ventricular (LV) strain and its serial changes with major adverse cardiac events (MACE) in hypertensive heart disease.
- To determine if LV strain provides predictive value independent of and incremental to clinical and LV geometric parameters.
Main Methods:
- Retrospective study of 388 asymptomatic hypertensive patients with abnormal LV geometry.
- Global longitudinal strain (GLS) measured by speckle tracking; patients followed for MACE over a median of 4 years.
- Cox proportional hazards model used to assess associations; risk score developed and validated.
Main Results:
- Major adverse cardiac events (MACE) were associated with concentric hypertrophy and impaired GLS (p < 0.01).
- GLS association with MACE was independent of and incremental to clinical factors and hypertrophy.
- Deterioration in GLS correlated with MACE; a risk score (age >70, AF, hypertrophy, baseline GLS) showed good discrimination (C-statistic 0.71).
Conclusions:
- Global longitudinal strain (GLS) and its deterioration are significant predictors of MACE in asymptomatic hypertensive heart disease.
- A risk score incorporating GLS is valuable for predicting MACE in this patient population.
Objectives:
This study sought to investigate the associations of left ventricular (LV) strain and its serial change with major adverse cardiac events (MACE) in hypertensive heart disease, independent of and incremental to clinical and LV geometric parameters.
Background:
In patients with hypertensive heart disease, MACE are associated with abnormal LV morphology, but their association with subclinical LV dysfunction is unclear.
Methods:
We retrospectively studied 388 asymptomatic nonischemic patients with hypertension who had abnormal LV geometry at a baseline echocardiogram between 2005 and 2014. Global longitudinal strain (GLS) was measured using speckle tracking. Patients were followed for MACE (death and admission because of heart failure, myocardial infarction, and strokes) over median of 4 years. A Cox proportional hazards model was used to assess the association of parameters with MACE.
Results:
MACE (n = 72; 19%) were associated with higher prevalence of concentric hypertrophy and impaired GLS (both, p < 0.01). The association of GLS with MACE was independent of and incremental to clinical parameters and concentric hypertrophy. Echocardiographic follow-up was performed in 55 patients (median duration, 3 years); deterioration in GLS was also associated with the 10 patients experiencing MACE after the second echo. A risk score was developed using age >70, atrial fibrillation, concentric hypertrophy, and baseline GLS >-16% from the derivation cohort (C statistic, 0.71), and a separate validation cohort showed it to have good discrimination for MACE (C statistic, 0.71).
Conclusions:
GLS and its deterioration are associated with MACE in asymptomatic hypertensive heart disease. A risk score incorporating strain was useful for predicting risk of MACE.
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