부산대학교 도서관

Introduction: Global circumferential strain (GCS) has been demonstrated to be sensitive marker of early cardiac pathology compared to conventional echocardiographic measurements. Improvement in speckle tracking echocardiography has introduced layer-specific quantification of GCS. This study investigated the differences in the prognostic value of endomyocardial (GCSEndo) and epimyocardial (GCSEpi) GCS regarding incident HF (heart failure) in the general population.Methods: The prospective cohort study included randomly invited individuals from the general population. All participants were examined with echocardiography. Exclusion criteria were prevalent HF at baseline, non-sinus rhythm during echocardiography and inadequate image quality for speckle tracking analysis. Cox proportional hazard regression models were utilized to assess associations between GCSEndo and GCSEpi with incident HF. A multivariable model was created, which included left ventricular (LV) ejection fraction, LV mass index, and the variables from the ARIC HF risk score.Results: A total of 2874 individuals were included in the study sample. Mean age was 53 years ± 18 years and 40% were males. Mean GCSEndo and GCSEpi were 31.9 ± 5.3% and 14.3 ± 4.0% respectively. During a follow-up period of 5.4 years (IQR: 4.5; 6.3) 52 suffered incident HF. The cumulative incidence of HF according to the medians of layer-specific GCS is illustrated in Figure 1. In multivariable Cox regressions, GCSEndo remained significantly associated with HF (HR = 1.06 95%CI: [1.00; 1.12], per 1 % decrease), while GCSEpi did not (HR = 1.01 95%CI: [0.94; 1.10], per 1 % decrease). The same pattern was observed when only adjusting for age and sex. Additionally, GCSEndo provided significantly higher Harrel’s C-statistics as compared to GCSEpi (0.68 95%CI[0.58; 0.77] vs 0.60 95%CI[0.50; 0.69]).Conclusions: In the general population, GCSEndo is independently associated with incident HF while GCSEpi is not.