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Published on: April 27, 2019
Global longitudinal strain is a predictor of mortality in patients with cardiogenic shock
Kristoffer Berg-Hansen1,2,3, Saki Ito1, Jae Oh1
1Department of Cardiovascular Medicine, Mayo Clinic Hospital, 200 First Street SW, Rochester, MN 55905, USA.
Insights
Global longitudinal strain (GLS) is a key predictor of mortality in patients with cardiogenic shock (CS). This echocardiographic measure offers superior prognostic value for both short- and long-term outcomes compared to traditional methods.
Area of Science:
- Cardiology
- Echocardiography
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) signifies severe cardiac dysfunction, requiring accurate left ventricular (LV) function assessment.
- Transthoracic echocardiography is crucial for evaluating LV function in CS patients.
- The prognostic utility of global longitudinal strain (GLS) in CS remains underexplored.
Purpose of the Study:
- To evaluate the prognostic significance of GLS in patients diagnosed with cardiogenic shock.
- To determine if GLS can improve risk stratification in CS patients.
Main Methods:
- Retrospective analysis of 623 patients with CS from 2007-2018.
- Transthoracic echocardiography performed within 24 hours of admission.
- Measurement of GLS and conventional echocardiographic parameters; categorization of LV dysfunction by GLS quartiles.
Main Results:
- Median LVEF was 31%, median GLS was 7.0%, and in-hospital mortality was 29%.
- Mortality increased progressively across GLS quartiles, from 17% to 42%.
- GLS was the sole independent echocardiographic predictor of in-hospital mortality (aOR 1.23 per 1% decrease) and independently predicted 1-year mortality (P < 0.001).
Conclusions:
- GLS independently predicts both short- and long-term mortality in patients with CS.
- GLS demonstrates superior prognostic value over conventional echocardiographic parameters for risk stratification in CS.
- GLS is a valuable tool for identifying high-risk patients within the cardiogenic shock population.
Aims:
Cardiogenic shock (CS) is a critical manifestation of severe cardiac dysfunction, necessitating precise evaluation of left ventricular (LV) function by transthoracic echocardiography. The prognostic value of global longitudinal strain (GLS) has not been examined in patients with CS. Therefore, we aimed to assess the prognostic significance of GLS in patients with CS.
Methods And Results:
This was a retrospective study of patients with CS from 2007 to 2018 who had a transthoracic echocardiography performed within 24 h of admission. GLS was measured, and conventional parameters were obtained. LV dysfunction was categorized by GLS: > 9.7% (Quartile 1), 7.0% < GLS ≤ 9.7% (Quartile 2), 5.0% < GLS ≤ 7.0% (Quartile 3), and ≤5.0% (Quartile 4). Outcomes included in-hospital and 1-year all-cause mortality. Among 623 patients with CS with the median LVEF of 31% [inter-quartile range (IQR): 24-41%] and the median GLS of 7.0% (IQR: 5.0-9.7%), in-hospital mortality was 29%. Mortality increased across GLS quartiles: Quartile 1: 17%; Quartile 2: 22%; Quartile 3: 35%; and Quartile 4: 42%. GLS remained the only independent echocardiographic predictor of in-hospital mortality after adjusting for clinical covariates (adjusted odds ratio: 1.23 per 1% decrease, 95% confidence interval: 1.04-1.46, P = 0.015). GLS independently predicted 1-year all-cause mortality (P < 0.001). The prognostic value of GLS was superior in cases with acute coronary syndrome. A classification and regression tree analysis identified GLS as the most important echocardiographic variable for predicting in-hospital mortality.
Conclusion:
GLS independently predicted short- and long-term mortality in patients with CS, surpassing conventional echocardiographic parameters in prognostic value, supporting its potential role in risk stratification in this population.
