Left Ventricular 3-Dimensional Global Longitudinal Strain Predicts All-Cause Mortality in Patients With Heart
Shuangshuang Zhu1,2,3, Chun Wu1,2,3, Yiwei Zhang1,2,3
1Department of Ultrasound Medicine Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China.
Insights
Three-dimensional left ventricular global longitudinal strain (3D-LVGLS) is a superior predictor of mortality in heart transplant recipients compared to 2D-LVGLS. This finding aids in better risk stratification for these patients.
Area of Science:
- Cardiology
- Transplant Medicine
- Echocardiography
Background:
- The prognostic significance of 3D-left ventricular global longitudinal strain (LVGLS) in heart transplant (HT) recipients is not well-established.
- Current prognostic models may not fully capture the risks associated with HT.
Purpose of the Study:
- To compare the prognostic value of 3D-LVGLS against 2D-LVGLS in predicting outcomes in HT recipients.
- To determine if 3D-LVGLS offers superior risk stratification capabilities.
Main Methods:
- Retrospective analysis of adult HT recipients undergoing comprehensive 2D and 3D echocardiography.
- Feasibility of 3D-LVGLS measurements assessed in 342 patients (86% success rate).
- All-cause mortality was the primary endpoint, analyzed using Cox regression and C-statistics.
Main Results:
- 3D-LVGLS demonstrated a significantly higher area under the curve (0.77 vs. 0.67, P=0.012) for predicting mortality compared to 2D-LVGLS.
- Lower 3D-LVGLS values correlated with worse patient outcomes (P<0.001).
- A multivariable model incorporating 3D-LVGLS showed improved predictive performance (C-statistic=0.814) versus 2D-LVGLS (C-statistic=0.772).
Conclusions:
- 3D-LVGLS is a potent predictor of all-cause mortality in heart transplant recipients.
- 3D-LVGLS provides greater prognostic value than 2D-LVGLS for risk stratification.
- Evaluating 3D-LVGLS holds significant potential for improving patient management in HT recipients.
Background:
The prognostic value of 3-dimensional (3D)-left ventricular global longitudinal strain (LVGLS) in recipients of heart transplant (HT) reremains unknown. This study aimed to determine whether 3D-LVGLS was the more powerful predictor of poor outcomes in recipients of HT compared with 2-dimensional (2D)-LVGLS.
Methods And Results:
All consecutive adult patients who received HT and underwent at least 1 comprehensive 2D and 3D transthoracic echocardiographic examination for clinical surveillance were retrospectively enrolled. The end point was all-cause mortality. Prognostic model performance was assessed according to the C-statistic. The 3D-LVGLS measurements were feasible in 294 of 342 patients with HT (86%). The median follow-up time was 53 months, and 44 HT redied. Receiver operating characteristic curves revealed that the area under the curve for predicting all-cause mortality was greater for 3D-LVGLS than 2D-LVGLS (0.77 versus 0.67, P=0.012). When HT stratified patients with HT into tertiles according to 3D-LVGLS values, patients with lower 3D-LVGLS had worse outcome (P<0.001). The multivariable Cox analysis showed that the model with 3D-LVGLS (hazard ratio [HR],1.44 [95% CI,1.24-1.68]; P<0.001; C-statistic=0.814) was better in predicting death than the model with 2D-LVGLS (HR, 1.19 [95% CI, 1.06-1.32]; P=0.002; C-statistic=0.772). The best cutoff value of 3D-LVGLS for detecting all-cause mortality was -16.1%, with a sensitivity of 63.6% and a specificity of 84.0%.
Conclusions:
The 3D-LVGLS was a powerful predictor of all-cause mortality in patients receiving HT and provided greater prognostic value than 2D-LVGLS. Our study highlighted the potential of evaluating 3D-LVGLS for risk stratification in recipients of HT.
