Key result
Abnormal global longitudinal strain with normal ejection fraction increased the risk of incident vascular events compared to normal function (HR 2.39; 95% CI 1.20-4.77).
Why the study?
Does abnormal global longitudinal strain predict incident vascular events in a community-based cohort?
Cohort (n=708)
Does abnormal global longitudinal strain predict incident vascular events in a community-based cohort?
Effect estimate: HR 2.39 (95% CI 1.20-4.77)
Subclinical left ventricular systolic dysfunction detected by global longitudinal strain is common and independently predicts cardiovascular events in a community-based cohort with normal LVEF.
May support GLS for vascular risk stratification in preserved EF; leaves open whether screening improves outcomes in community cohorts.
AIMS: Global longitudinal strain (GLS) assessed by speckle-tracking echocardiography has been proposed as a parameter able to reflect early changes in left ventricular systolic function at a stage when left ventricular ejection fraction (LVEF) is still normal. This study aimed at assessing prevalence and prognostic value of left ventricular systolic dysfunction (LVSD) assessed by echocardiographic speckle-tracking GLS in a community-based cohort. METHODS AND RESULTS: Participants from the community-based prospective Northern Manhattan Study underwent two-dimensional transthoracic echocardiography as part of the Cardiovascular Abnormalities and Brain Lesions study. Left ventricular systolic function was assessed by LVEF and speckle-tracking GLS. Subjects were followed annually (mean = 4.8 ± 1.5 years) and incident vascular events (ischaemic stroke, myocardial infarction, and vascular death) were reviewed and adjudicated. Of the 708 study participants, 114 (16.1%) had abnormal GLS but normal LVEF (GLS-LVSD), 30 (4.2%) had abnormal LVEF (LVEF-LVSD), and 564 (79.7%) had normal GLS and LVEF (no-LVSD). In multivariate analysis, risk of events was significantly greater in GLS-LVSD [adjusted hazard ratio (HR) = 2.39, 95% confidence interval (CI) = 1.20-4.77] and in LVEF-LVSD (adjusted HR = 3.51, 95% CI = 1.25-9.88) compared with no-LVSD. Among participants with normal LVEF, lower GLS was significantly associated with events (adjusted HR/unit decrease = 1.15, 95% CI = 1.03-1.28) whereas LVEF was not (adjusted HR/unit decrease = 1.01, 95% CI = 0.94-1.07). The GLS prognostic value was incremental to risk factors and LVEF both in the overall population (chi-square change = 7.406, P = 0.006) and in participants with normal LVEF (chi-square change = 6.357, P = 0.012). CONCLUSION: In a community-based cohort, GLS-LVSD was four times more frequent than LVEF-LVSD. GLS-LVSD was a powerful and independent predictor of cardiovascular events. Left ventricular function assessment by GLS may improve cardiovascular risk stratification in subjects with normal LVEF.
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Russo et al. (2014) conducted a cohort in Community-based cohort (n=708). Abnormal global longitudinal strain (GLS-LVSD) vs. Normal GLS and LVEF (no-LVSD) was evaluated on Incident vascular events (ischaemic stroke, myocardial infarction, and vascular death) (HR 2.39, 95% CI 1.20-4.77). Abnormal global longitudinal strain with normal ejection fraction increased the risk of incident vascular events compared to normal function (HR 2.39; 95% CI 1.20-4.77).
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