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Published on: March 27, 2018
Prognostic value of Layer-Specific global longitudinal strain in patients undergoing Coronary Artery Bypass Grafting
Filip Soeskov Davidovski1,2, Mats Christian Højbjerg Lassen3,4, Kristoffer Grundtvig Skaarup3,4
1Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark. filip.soeskov.davidovski@regionh.dk.
Insights
Layer-specific global longitudinal strain (GLS) predicts mortality and heart failure (HF) after coronary artery bypass grafting (CABG). Epicardial GLS (GLSepi) remained a significant predictor of mortality even after adjusting for EuroSCORE II.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
- Assessing long-term outcomes after CABG is crucial for patient management.
- Global longitudinal strain (GLS) is an emerging echocardiographic parameter for evaluating left ventricular function.
Purpose of the Study:
- To investigate the prognostic significance of layer-specific global longitudinal strain (GLS) in patients undergoing CABG.
- To determine if GLS parameters can predict mortality, heart failure (HF), and cardiovascular death (CVD) post-CABG.
Main Methods:
- Retrospective cohort study of 641 patients undergoing isolated CABG.
- Layer-specific GLS assessed using two-dimensional speckle tracking echocardiography.
- Follow-up via national registries for all-cause mortality, HF, and the composite endpoint of HF/CVD.
Main Results:
- Patients who died had significantly reduced GLS in endocardial, mid-wall, and epicardial layers.
- Decreasing absolute GLS in all layers was linearly associated with increased mortality risk.
- Epicardial GLS (GLSepi) remained an independent predictor of mortality after adjustment for EuroSCORE II.
Conclusions:
- Layer-specific GLS is a valuable independent prognostic marker for mortality and adverse cardiovascular outcomes after CABG.
- GLSepi demonstrates significant prognostic utility for mortality, particularly when adjusted for established risk scores like EuroSCORE II.
Purpose:
To determine the prognostic value of layer-specific global longitudinal strain (GLS) after coronary artery bypass grafting (CABG).
Methods:
This retrospective cohort study comprised 641 patients undergoing isolated CABG between 2006 and 2011. Layer-specific GLS was assessed by echocardiography using two-dimensional speckle tracking. Patients were followed through nation-wide registries for all-cause mortality, heart failure (HF), and the composite endpoint of HF or cardiovascular death (CVD) (HF/CVD).
Results:
During follow-up (3.8 years [IQR: 2.7; 4.9]), 73 patients died, and 62 developed HF/CVD (HF: n = 30, CVD: n = 38). Patients who died had reduced GLS in all layers; GLSendo (-14.2% vs. - 16.3%, p < 0.001), whole wall GLS (-12.1% vs. - 13.9%, p < 0.001), and GLSepi (-10.6% vs. - 12.2%, p < 0.001). The risk of death increased linearly with decreasing absolute GLS for all layers (p < 0.0002). In multivariable Cox models adjusted for clinical and echocardiographic baseline characteristics, all layer-specific strain parameters remained significantly associated with mortality. However, only GLSepi remained significant after adjusting for European System for Cardiac Operative Risk Evaluation II (EuroSCORE II); (GLSepi: HR = 1.09 (1.00-1.18), p = 0.043, per 1% absolute decrease). For secondary outcomes (HF and HF/CVD), all strain parameters were associated with HF/CVD in fully adjusted models; however, no layer was independently associated with HF after multivariable analysis.
Conclusion:
Layer-specific GLS is an independent prognosticator of all-cause mortality, HF, and HF/CVD. In multivariable models for mortality, GLSepi provided significant prognostic value after adjusting for EuroSCORE II.
