Incremental value of myocardial global longitudinal strain in predicting major adverse cardiac events among patients...

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Endocardial global longitudinal strain (endo-GLS) from echocardiography is linked to myocardial fibrosis (MF) and prognosis in hypertrophic cardiomyopathy (HCM).
• Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) identifies MF in hypertrophic septal or ventricular walls.
• The prognostic value of myocardial layer GLS (myo-GLS) relative to endocardial GLS (endo-GLS) in HCM requires further investigation.

Purpose of the Study:

• To investigate if myo-GLS correlates more strongly with LGE extent (%LGE) than endo-GLS.
• To determine if myo-GLS is a more powerful prognostic factor for major adverse cardiac events (MACE) than endo-GLS in HCM patients.

Main Methods:

• Retrospective analysis of 177 HCM inpatients (May 2019-April 2021).
• 162 patients underwent echocardiography and contrast-enhanced CMR within 7 days.
• Blind assessment of myo-GLS and %LGE in a core laboratory, with post-discharge follow-up.

Main Results:

• During 33.77 months follow-up, 14 participants (7.91%) experienced MACE.
• Myo-GLS showed a stronger association with %LGE (r=-.68) than endo-GLS (r=-.64).
• Absolute myo-GLS independently predicted MACE (aHR=0.75), and it better detected MACE+ patients (AUC 0.939) than endo-GLS (AUC 0.898).

Conclusions:

• Myocardial global longitudinal strain (myo-GLS) is a more potent predictor of MACE in HCM patients compared to endocardial GLS (endo-GLS).
• Myo-GLS demonstrates a high correlation with the extent of myocardial fibrosis (%LGE).
• Myo-GLS offers enhanced prognostic value for identifying MACE risk in HCM.