Left ventricular global longitudinal strain in predicting CRT response: one more J-shaped curve in medicine
Michal Orszulak1, Artur Filipecki2, Wojciech Wrobel2
1First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland. orszul@vp.pl.
Insights
Left ventricular global longitudinal strain (LVGLS) can predict cardiac resynchronization therapy (CRT) response. Mid-range LVGLS values identify patients likely to benefit from CRT, particularly those with non-ischemic heart failure.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) patients with reduced ejection fraction and left bundle branch block.
- Predicting CRT response remains a challenge, necessitating improved prognostic markers.
- Left ventricular global longitudinal strain (LVGLS) assessed by speckle-tracking echocardiography is a sensitive measure of myocardial function.
Purpose of the Study:
- To evaluate the additive prognostic value of baseline LVGLS in predicting CRT response.
- To identify optimal LVGLS values for characterizing potential CRT responders.
- To explore the relationship between LVGLS and CRT response in different HF etiologies.
Main Methods:
- Forty-nine heart failure patients undergoing CRT implantation were studied.
- Transthoracic echocardiography with speckle-tracking was performed before and after CRT.
- CRT response was defined as a ≥15% reduction in left ventricular end-systolic volume (ΔLVESV).
- Patients were categorized into "mid-range LVGLS" and "peripheral LVGLS" groups based on baseline strain percentiles.
Main Results:
- A significant difference in ΔLVESV was observed between "mid-range LVGLS" (33.3%) and "peripheral LVGLS" (16.2%) groups (p < 0.001).
- In non-ischemic HF patients, 100% of the "mid-range LVGLS" group responded to CRT, compared to 55% in the "peripheral LVGLS" group (p = 0.015).
- Baseline LVGLS demonstrated an inverted J-shaped relationship with CRT response, suggesting a non-linear association.
Conclusions:
- Baseline LVGLS shows potential as a prognostic marker for CRT response.
- "Mid-range LVGLS" values are associated with better CRT outcomes, especially in non-ischemic heart failure.
- LVGLS may aid in selecting appropriate candidates for CRT, optimizing treatment efficacy.
Abstract:
The aim of the study was: (1) to verify the hypothesis that left ventricular global longitudinal strain (LVGLS) may be of additive prognostic value in prediction CRT response and (2) to obtain such a LVGLS value that in the best optimal way enables to characterize potential CRT responders. Forty-nine HF patients (age 66.5 ± 10 years, LVEF 24.9 ± 6.4%, LBBB 71.4%, 57.1% ischemic aetiology of HF) underwent CRT implantation. Transthoracic echocardiography was performed prior to and 15 ± 7 months after CRT implantation. Speckle-tracking echocardiography was performed to assess longitudinal left ventricular function as LVGLS. The response to CRT was defined as a ≥ 15% reduction in the left ventricular end-systolic volume (∆LVESV). Thirty-six (73.5%) patients responded to CRT. There was no linear correlation between baseline LVGLS and ∆LVESV (r = 0.09; p = 0.56). The patients were divided according to the percentile of baseline LVGLS: above 80th percentile; between 80 and 40th percentile; below 40th percentile. Two peripheral groups (above 80th and below 40th percentile) formed "peripheral LVGLS" and the middle group was called "mid-range LVGLS". The absolute LVGLS cutoff values were - 6.07% (40th percentile) and - 8.67% (80th percentile). For the group of 20 (40.8%) "mid-range LVGLS" patients mean ΔLVESV was 33.3 ± 16.9% while for "peripheral LVGLS" ΔLVESV was 16.2 ± 18.8% (p < 0.001). Among non-ischemic HF etiology, all "mid-range LVGLS" patients (100%) responded positively to CRT (in "peripheral LVGLS"-55% responders; p = 0.015). Baseline LVGLS may have a potential prognostic value in prediction CRT response with relationship of inverted J-shaped pattern. "Mid-range LVGLS" values should help to select CRT responders, especially in non-ischemic HF etiology patients.
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