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Published on: October 20, 2016
Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Congenital Heart Disease
Alexander C Egbe1, William R Miranda1, Jason H Anderson1
1Department of Cardiovascular Medicine, Mayo Clinic Rochester, MN.
Insights
Left ventricular global longitudinal strain (LVGLS) helps identify adults with congenital heart disease and recovered ejection fraction who are at risk for adverse cardiovascular events. Higher LVGLS indicates lower risk, suggesting its utility in risk stratification.
Area of Science:
- Cardiology
- Echocardiography
- Congenital Heart Disease
Background:
- Left ventricular global longitudinal strain (LVGLS) aids risk stratification in patients with left ventricular (LV) systolic dysfunction and recovered LV ejection fraction (LVEF) in acquired heart disease.
- Adults with congenital heart disease (CHD) and LV systolic dysfunction are a unique population requiring specific risk assessment.
Purpose of the Study:
- To evaluate the association between LVGLS and cardiovascular events or LVEF deterioration in adults with CHD and previously impaired LVEF.
- To determine if LVGLS can identify patients at higher risk for adverse outcomes despite LVEF recovery.
Main Methods:
- Retrospective cohort study of CHD patients with prior LV systolic dysfunction (LVEF <50%) and subsequent LVEF recovery (≥10% increase to ≥50%).
- Patients categorized into normal (absolute LVGLS >18%) and abnormal (absolute LVGLS ≤18%) groups based on index echocardiogram.
- Analysis of cardiovascular events (HF hospitalization, VT/shock, transplant, CV death) and LVEF deterioration (≥10% decrease to <50%).
Main Results:
- Of 193 patients with recovered LVEF, 45% had normalized LVGLS.
- Higher absolute LVGLS was linked to a lower risk of cardiovascular events and LVEF deterioration.
- Hypertension was associated with an increased risk of adverse cardiovascular outcomes.
Conclusions:
- Adults with CHD and recovered LVEF remain at risk for adverse outcomes.
- LVGLS is a valuable tool for identifying high-risk individuals within this population.
- Further clinical trials are needed to validate the impact of medical therapies on reducing adverse outcomes.
Background:
Left ventricular global longitudinal strain (LVGLS) has been shown to improve risk stratification in patients with LV systolic dysfunction and subsequent recovery of LV ejection fraction (LVEF) in the acquired heart disease population. The purpose of this study was to assess the relationship between LVGLS and cardiovascular events (heart failure hospitalization, sustained ventricular tachycardia/appropriate shock, heart transplant, or cardiovascular death) and deterioration in LVEF (absolute decrease in LVEF ≥10% to LVEF <50%) in adults with congenital heart disease.
Methods:
Retrospective cohort study of congenital heart disease patients with previous diagnosis of LV systolic dysfunction (LVEF <50%) and subsequent recovery of LVEF (absolute increase in LVEF of ≥10% to LVEF ≥50%) on subsequent echocardiogram (index echocardiogram). Based on the index echocardiogram, patients were divided into normal LVGLS (absolute LVGLS >18%) versus abnormal LVGLS (absolute LVGLS ≤18%) groups.
Results:
Of 193 patients with recovered LVEF, 86 (45%) had normalization of LVGLS at index echocardiogram. A higher absolute LVGLS and use of renin angiotensin aldosterone system antagonist was associated with a lower risk of cardiovascular events and subsequent deterioration in LVEF, while hypertension was associated with higher risk of cardiovascular events and deterioration in LVEF.
Conclusions:
These results suggest that patients with congenital heart disease with recovered LVEF remained at risk for adverse outcomes, and LVGLS can be used to identify patients at risk for adverse outcomes. Medical therapy for heart failure and treatment of hypertension may reduce the risk of adverse outcome, but these findings require empirical validation, hence the need for a clinical trial.
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