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Global longitudinal strain predicts cardiovascular events after coronary artery bypass grafting
Flemming Javier Olsen1, Søren Lindberg2, Sune Pedersen2
1Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark flemming.j.olsen@gmail.com.
Insights
Global longitudinal strain (GLS) predicts long-term outcomes after coronary artery bypass grafting (CABG). Its predictive power is strongest in patients with preserved left ventricular ejection fraction (LVEF).
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Assessing long-term prognosis after coronary artery bypass grafting (CABG) is crucial for patient management.
- Left ventricular ejection fraction (LVEF) is a standard measure, but novel markers may offer enhanced predictive value.
Purpose of the Study:
- To evaluate the prognostic significance of global longitudinal strain (GLS) in predicting outcomes following CABG.
- To determine if GLS provides additive predictive value beyond established risk scores like EuroSCORE-II.
Main Methods:
- Retrospective cohort study of 709 patients undergoing CABG (2006-2011) with available echocardiograms for strain analysis.
- Follow-up via nationwide registries for all-cause mortality, cardiovascular death (CVD), and major adverse cardiovascular events (MACE).
- Multivariable Cox regression and Net Reclassification Index (NRI) used for analysis, adjusting for EuroSCORE-II.
Main Results:
- GLS was an independent predictor of all-cause mortality, CVD, and MACE after adjusting for EuroSCORE-II.
- GLS significantly improved NRI for MACE prediction when added to EuroSCORE-II.
- The association between GLS and outcomes was modified by LVEF, with stronger prediction in patients with preserved LVEF (≥50%).
Conclusions:
- Global longitudinal strain (GLS) is a valuable independent predictor of long-term outcomes post-CABG.
- GLS offers enhanced prognostic information, particularly in patients with preserved LVEF.
- These findings support the integration of GLS into routine echocardiographic assessment after CABG.
Objective:
To determine the prognostic value of global longitudinal strain (GLS) after coronary artery bypass grafting (CABG).
Methods:
We performed a retrospective cohort study on patients undergoing CABG between 2006 and 2011 who had an echocardiogram available for strain analysis. The patients were followed up through nationwide registries for development of all-cause mortality, cardiovascular death (CVD) and major adverse cardiovascular events (MACEs) defined as heart failure hospitalisation and/or CVD. Multivariable Cox regression was applied to adjust for the European System for Cardiac Operative Risk Evaluation II (EuroSCORE-II). Additive value was assessed by Net Reclassification Index (NRI) improvement.
Results:
Of the 709 patients included, 80 died during a median follow-up of 3.8 years. Of these, 45 had CVD, and 72 patients experienced MACE. Mean age was 68 years and 85% were men. Left ventricular ejection fraction (LVEF) was 50% and GLS was -13%.GLS was an independent predictor when adjusted for the EuroSCORE-II (all-cause mortality: HR=1.07 (1.01-1.13), p=0.018; CVD: HR=1.11 (1.03-1.20), p=0.007; MACE: HR=1.12 (1.06-1.19), p<0.001, per 1% absolute decrease). GLS significantly improved the NRI score by 0.30 when added to the EuroSCORE-II for predicting MACE, but not significantly for the other endpoints.LVEF modified the association between GLS and outcomes (p for interaction<0.05 for CVD and MACE). GLS remained an independent predictor of outcomes in patients with preserved LVEF (LVEF≥50%) and improved the NRI score when added to the EuroSCORE-II for predicting CVD and MACE, but not all-cause mortality in these patients.
Conclusion:
GLS is an independent predictor of long-term outcomes after CABG. The predictive value appears strongest among patients with preserved LVEF.
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