학술논문
MODERATED POSTER SESSION: Diseases impact on left ventricular function: Friday 5 December 2014, 08:30-18:00 * Location: Moderated Poster area
Document Type
Article
Author
Rangel, I; Goncalves, A; Sousa, C; Almeida, PB; Rodrigues, J; Macedo, F; Silva-Cardoso, J; Maciel, MJ; Adam, D; Khamis, H; Friedman, Z; Smirin, N; Hagendorff, A; Shimoni, S; Georgievska-Ismail, L; Hristovski, Z; Projevska-Donegati, D; Berezin, A; Kremzer, A; Samura, T; Berezina, T; Ternacle, J; Bodez, D; Guellich, A; Rappeneau, S; Dubois-Rande, J-L; Tissot, C-M; Hittinger, L; Plante-Bordeneuve, V; Deux, J-F; Damy, T; Gillebert, T C; Chirinos, J A; Rietzschel, E R; Shiva-Kumar, P; De Buyzere, M L; Zamani, P; Claessens, T C; Akers, S R; De Bacquer, D; Segers, P; Investigators, The Asklepios; Blazquez Bermejo, Z; Caro Codon, J; Lopez Fernandez, T; Valbuena, S; Mori Junco, R; Ponz De Antonio, I; Gemma, D; Rosillo Rodriguez, SO; Moreno Yanguela, M; Lopez-Sendon, JL; MEdicamentos, Grupo de Estudio de CArdiotoxicidad por; Tosello, F; Leone, D; Bruno, G; Ravera, A; Fabbri, A; Sabia, L; Avenatti, E; Milazzo, V; Veglio, F; Milan, A; Cimino, S; Cicogna, F; Cantisani, D; Trivigno, M; Caira, C; Pedrizzetti, G; Tonti, G; Agati, L; Malev, E; Zemtsovsky, E; Omelchenko, M; Vasina, L
Source
European Journal of Echocardiography; December 2014, Vol. 15 Issue: Supplement 2 pii165-ii165, 1p
Subject
Language
ISSN
15252167; 15322114
Abstract
Background: The risk stratification of chronic heart failure (CHF) patients can be performed using echocardiographic markers of left ventricle (LV) dysfunction, such as the ejection fraction (EF). LV global longitudinal strain (GLS) showed to be a sensitive measure of myocardium deformation. However, its role as prognostic marker in CHF patients with exclusively systolic dysfunction is still poorly addressed. Objectives: This study sought to evaluate the incremental prognostic role of two-dimensional (2D) LV GLS in CHF outpatients. Methods: Fifty-five patients with CHF and LVEF ≤45% performed a 2D echocardiogram with assessment of conventional parameters and GLS by speckle tracking (STE) imaging averaged from apical 4-chamber, 3-chamber and 2-chamber views. A clinical follow-up of 12 months was performed to assess the occurrence of composite endpoint of overall mortality and nonfatal cardiovascular events. Results: We included 55 patients (mean age 55 ± 12 years, 80% males, 30% with CHF of ischemic etiology, with mean LVEF of 27 ± 9%, median BNP levels 162 [P25-75 56-542] pg/ml). The mean GLS was – 10.35 ± 3.14%. GLS was significantly correlated with NYHA functional class (R=0.41, p=0.002) and BNP levels (r=0.47, p=0.001) and showed a good correlation with LVEF (r=-0.687, p<0.001). The logistic regression analysis showed that GLS (OR 1.548 [95% CI 1.169-2.051]) and LVEF (OR 0.895 [95% CI 0.822-0.976]) were significantly associated with the composite end-point. Other variables that were significantly related with GLS included NYHA functional class (OR 7.333 [95% CI 2.084-25.809]) and BNP levels (OR 1.003 [95% CI 1.001-1.005]). Multivariated regression analysis, including GLS and LVEF, showed an independent association of GLS with adverse outcome (OR 1.460 [95% CI 1.036-2.058]). The area under the receiver operating characteristic (ROC) curve to predict the occurrence of the composite endpoint was 0.798 [0.678-0.919] with an optimal thresholds of -9.5 (80% sensitivity, 70% specificity, p=0.001), while EF had an area under the ROC curve of 0.276 [0.138-0.414]. Conclusions: GLS was strongly associated with severity disease status and predicted the occurrence of adverse outcomes. Quantifying LV GLS in CHF outpatients with systolic dysfunction provides greater accuracy for cardiovascular risk stratification than LVEF.