Association Between Global Longitudinal Strain and Cardiovascular Events in Patients With Left Bundle Branch Block
In-Chang Hwang1, Goo-Yeong Cho2, Yeonyee E Yoon2
1Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Insights
Left ventricular global longitudinal strain (GLS) better predicts cardiovascular events in left bundle branch block (LBBB) patients than ejection fraction. Impaired GLS identifies high-risk individuals, even with preserved ejection fraction.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Mechanics
Background:
- The prognostic significance of left ventricular (LV) global strain and twist in patients with left bundle branch block (LBBB) remains incompletely understood.
- Assessing myocardial mechanics is crucial for risk stratification in LBBB patients.
Purpose of the Study:
- To investigate the association between LV myocardial strain and twist and cardiovascular events in LBBB patients.
- To compare the prognostic value of LV global strain and twist with established clinical and echocardiographic parameters.
Main Methods:
- Retrospective analysis of 269 LBBB patients using two-dimensional speckle-tracking echocardiography.
- Measurement of LV global longitudinal strain (GLS), global circumferential strain, and twist.
- Comparison of LV global function parameters with clinical risk factors, LV ejection fraction (LVEF), and a composite endpoint of cardiovascular mortality and heart failure hospitalization.
Main Results:
- The composite endpoint occurred in 20.4% of patients over a median follow-up of 27.5 months.
- Univariate analysis showed associations between the composite endpoint and diabetes, chronic kidney disease, ischemic LBBB etiology, dilated left atrium, reduced LVEF, dilated LV, and impaired LV global strain (GLS > -12.2%), global circumferential strain (> -11.8%), and twist (< 6.5°).
- Multivariate analysis revealed GLS (adjusted hazard ratio, 4.697) was significantly associated with the composite endpoint, while global circumferential strain, twist, and LVEF were not. GLS provided additive prognostic value over clinical factors and LVEF. Patients with preserved LVEF but impaired GLS experienced more events than those with impaired LVEF but preserved GLS.
Conclusions:
- Global longitudinal strain (GLS) offers superior risk stratification compared to LV ejection fraction (LVEF) and other echocardiographic parameters in patients with LBBB.
- GLS can identify high-risk individuals among LBBB patients, including those with preserved LVEF.
Background:
The prognostic value of left ventricular (LV) global strain and twist in patients with left bundle branch block (LBBB) is not fully investigated. The aim of this study was to investigate the association between myocardial strain and twist and cardiovascular events in patients with LBBB, as assessed using two-dimensional speckle-tracking echocardiography.
Methods:
A total of 269 patients with LBBB (mean age, 69.5 ± 10.9 years; 46.8% men) were retrospectively identified. Using speckle-tracking, LV global longitudinal strain (GLS), global circumferential strain, and twist were measured. Association between LV global function and a composite of cardiovascular mortality and hospitalization for heart failure was compared with clinical risk factors, LV ejection fraction (LVEF), and other echocardiographic parameters.
Results:
During a median of 27.5 months (interquartile range, 12.8-43.9 months), the composite end point occurred in 55 patients (20.4%). In univariate analyses, diabetes mellitus, chronic kidney disease, ischemic etiology of LBBB, dilated left atrium, reduced LVEF, dilated left ventricle, and impaired LV global strain (GLS > -12.2%, global circumferential strain > -11.8%, and twist < 6.5°) showed associations with the composite end point. In multivariate analyses, GLS was significantly associated with the composite end point (adjusted hazard ratio, 4.697; 95% CI, 1.344-16.413; P = .015), whereas global circumferential strain, twist, and LVEF were not. GLS showed an additive association with poor prognosis over clinical risk factors and other echocardiographic parameters, including LVEF. Patients with preserved LVEFs (≥40%) but impaired GLS (>-12.2%) had a larger number of clinical events than those with impaired LVEFs but preserved GLS.
Conclusions:
Among patients with LBBB, GLS can provide better risk stratification than LVEF or other echocardiographic parameters.
Related Concept Videos
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies