Global Longitudinal Strain as a Major Predictor of Cardiac Events in Patients with Depressed Left Ventricular Function: A Multicenter Study

Mignot, Aude; Donal, Erwan; Zaroui, Amira; Reant, Patricia; Salem, Adrien; Hamon, Cecile; Monzy, Severine; Roudaut, Raymond; Habib, Gilbert; Lafitte, Stéphane

doi:10.1016/j.echo.2010.07.019

« Previous Next »Journal of the American Society of Echocardiography
Volume 23, Issue 10 , Pages 1019-1024, October 2010

Global Longitudinal Strain as a Major Predictor of Cardiac Events in Patients with Depressed Left Ventricular Function: A Multicenter Study

Aude Mignot, MD
- Cardiologic Hospital and INSERM 828, Bordeaux University Hospital Center, Pessac, France
Erwan Donal, MD, PhD
- Pontchaillou University Hospital Center, Rennes, France
Amira Zaroui, MD
- Cardiologic Hospital and INSERM 828, Bordeaux University Hospital Center, Pessac, France
Patricia Reant, MD
- Cardiologic Hospital and INSERM 828, Bordeaux University Hospital Center, Pessac, France
Adrien Salem, MD
- Timone Hospital, Cardiology Department, Marseille, France
Cecile Hamon, MD
- Pontchaillou University Hospital Center, Rennes, France
Severine Monzy, MD
- Cardiologic Hospital and INSERM 828, Bordeaux University Hospital Center, Pessac, France
Raymond Roudaut, MD, PhD
- Cardiologic Hospital and INSERM 828, Bordeaux University Hospital Center, Pessac, France
Gilbert Habib, MD, PhD
- Timone Hospital, Cardiology Department, Marseille, France
Stéphane Lafitte, MD, PhD
- Cardiologic Hospital and INSERM 828, Bordeaux University Hospital Center, Pessac, France
- Address reprint requests to Stéphane Lafitte, MD, PhD, Service des Echocardiographies, Hôpital Cardiologique Haut-Lévêque, Avenue Magellan, Pessac 33600, France.

published online 02 September 2010.

Background

The risk stratification of patients with left ventricular (LV) dysfunction can be performed using echocardiographic parameters such as the ejection fraction (EF). Recently, new technologies based on deformation measurements have been shown to identify early myocardial dysfunction before EF decrease. Consequently, tools such as two-dimensional strain have been incorporated into echocardiographic systems, allowing for fast, reliable, and reproducible calculation of longitudinal components of LV systolic deformation. The hypothesis in this study was that as a more sensitive marker of LV dysfunction, longitudinal strain would allow for the risk stratification of patients with heart failure.

Methods

This multicenter study included 147 patients with heart failure with LV EFs ≤ 45% (mean age, 64 ± 14 years; 74% men; mean LV EF, 29.9 ± 8.9%). Conventional echocardiographic parameters as well as global and segmental longitudinal strain were measured and compared with these values in a control population. Patients were monitored for cardiac events, defined as a composite criterion, over 12 months.

Results

Clinical events were observed in 20% of patients during the 12-month follow-up period. On receiver operating characteristic curve analysis, global longitudinal strain had the highest prognostic value (area under the curve, 0.83) and the highest combination of sensitivity (73%) and specificity (83%), using a cutoff value of −7%.

Conclusion

Strain assessment is highly feasible and reliable in patients with LV dysfunction and allows for cardiovascular risk stratification in patients with heart failure with greater accuracy than LV EF.

Keywords: Chronic cardiomyopathy with left ventricular dysfunction, Strain, Cardiac outcome

Abbreviations: EF, Ejection fraction, DTI, Doppler tissue imaging, GLS, Global longitudinal strain, HF, Heart failure, LV, Left ventricular, MR, Mitral regurgitation, NYHA, New York Heart Association, 2D, Two-dimensional