Predictive value of global longitudinal strain by left ventricular ejection fraction

Area of Science:

• Cardiology
• Echocardiography
• Heart Failure Management

Background:

• The prognostic value of left ventricular (LV) global longitudinal strain (GLS) across different left ventricular ejection fraction (LVEF) categories remains unclear.
• Assessing LV GLS in heart failure (HF) patients stratified by LVEF is crucial for refining risk prediction.

Purpose of the Study:

• To evaluate the predictive capability of LV GLS for clinical outcomes in heart failure patients with varying LVEF.
• To determine if LV GLS provides incremental prognostic information beyond traditional parameters in different LVEF subgroups.

Main Methods:

• Analysis of 1077 patients from the MADIT-CRT trial with available 2D speckle tracking data.
• Stratification of patients into LVEF ≤ 30% (n=640) and LVEF > 30% (n=437) groups.
• Assessment of primary (ventricular tachycardia/fibrillation or death) and secondary (heart failure or death) endpoints based on LV GLS tertiles.

Main Results:

• In patients with LVEF ≤ 30%, higher LV GLS tertiles correlated with increased rates of VT/VF/death and HF/death.
• LV GLS independently predicted VT/VF or death (T1 vs. T2/3 HR=1.67) and HF/death (T1 vs T2/3 HR=2.00) in the LVEF ≤ 30% group.
• These predictive associations were not significant in the LVEF > 30% subgroup.

Conclusions:

• LV GLS is a valuable independent predictor of adverse outcomes (VT/VF, HF/death) in heart failure patients with LVEF ≤ 30%.
• LV GLS does not appear to offer significant prognostic value in heart failure patients with LVEF > 30% within the MADIT-CRT cohort.
• These findings highlight the importance of LVEF in the interpretation of LV GLS for risk stratification in heart failure.