Lower ventricular longitudinal function measured by AVPD and GLS independently predicted cardiovascular mortality and morbidity in HFrEF patients (HR 1.12 per-mm-decrease and HR 1.13 per-%-increase).
Cohort (n=287)
Does ventricular longitudinal function (AVPD and GLS) measured by cardiovascular magnetic resonance predict cardiovascular morbidity and mortality in patients with HFrEF?
Ventricular longitudinal function measured by CMR (AVPD and GLS) provides independent prognostic value for predicting recurrent cardiovascular events and hospitalizations in patients with HFrEF.
Effect estimate: HR 1.12 per-mm-decrease (AVPD) and HR 1.13 per-%-increase (GLS)
p-value: p=<0.001
AIMS: Ventricular longitudinal function measured as basal-apical atrioventricular plane displacement (AVPD) or global longitudinal strain (GLS) is a potent predictor of mortality and could potentially be a predictor of heart failure-associated morbidity. We hypothesized that low AVPD and GLS are associated with the combined endpoint of cardiovascular mortality and heart failure-associated morbidity. METHODS AND RESULTS: Two hundred eighty-seven patients (age 62 ± 12 years, 78% male) with heart failure with reduced (≤40%) ejection fraction (HFrEF) referred to a cardiovascular magnetic resonance exam were included. Ventricular longitudinal function, ventricular volume, and myocardial fibrosis or infarction were analysed from cine and late gadolinium enhancement images. National registries provided data on causes of cardiovascular hospitalizations and cardiovascular mortality for the combined endpoint. Time-to-event analysis capable of including reoccurring events was employed with a 5-year follow-up. HFrEF patients had EF 26.5 ± 8.0%, AVPD 7.8 ± 2.4 mm, and GLS -7.5 ± 3.0%. In contrast, ventricular longitudinal function was approximately twice as large in an age-matched control group (AVPD 15.3 ± 1.6 mm; GLS -20.6 ± 2.0%; P -6.1%) overall experienced more than 3 times as many events as the top tertile (>8.8 mm or <-8.4%; P < 0.001). Patients in this tertile also faced more cardiovascular deaths (P < 0.05), HF hospitalizations (P = 0.001), myocardial infarctions (only GLS: P = 0.032), and accumulated longer in-hospital length-of-stay overall (AVPD 20.9 vs. 9.1 days; GLS 22.4 vs. 6.5 days; P = 0.001 for both), and from HF hospitalizations (AVPD 19.3 vs. 8.3 days; GLS 19.3 vs. 5.4 days; P = 0.001 for both). In multivariate analysis adjusted for significant covariates, AVPD and GLS remained independent predictors of events (hazard ratio 1.12 per-mm-decrease and 1.13 per-%-increase) alongside hyponatremia (<135 mmol/L), aetiology of HF, and LV end-diastolic volume index. CONCLUSIONS: Low ventricular longitudinal function is associated with an increase in number of events as well as longer in-hospital stay from cardiovascular causes. In addition, AVPD and GLS have independent prognostic value for cardiovascular mortality and morbidity in HFrEF patients.
Berg et al. (Mon,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=287). Ventricular longitudinal function (AVPD and GLS) by CMR vs. Top vs bottom tertiles of AVPD/GLS was evaluated on Combined endpoint of cardiovascular mortality and heart failure-associated morbidity (HR 1.12 per-mm-decrease (AVPD) and HR 1.13 per-%-increase (GLS), p=<0.001). Lower ventricular longitudinal function measured by AVPD and GLS independently predicted cardiovascular mortality and morbidity in HFrEF patients (HR 1.12 per-mm-decrease and HR 1.13 per-%-increase).