Predictive Value of Global Longitudinal Strain by Left Ventricular Ejection Fraction

Q: What does this research mean for the field?

Left ventricular global longitudinal strain (LV GLS) independently predicts the risk of ventricular tachycardia/fibrillation, heart failure, and death in heart failure patients with an LVEF ≤ 30%, but lacks predictive value in patients with an LVEF > 30%. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Diego Medvedofsky; Genevieve Arany‐Lao‐Kan; Scott McNitt; Roberto M. Lang; Roderick Tung; Scott D. Solomon; Béla Merkely; Ilan Goldenberg; Valentina Kutyifa

doi:10.1002/ehf2.14193

March 29, 2023ESC Heart FailureOpen Access

Predictive Value of Global Longitudinal Strain by Left Ventricular Ejection Fraction

View Full Paper

Ask AI

Bookmark

Share

Why the study?

The predictive value of left ventricular global longitudinal strain to predict outcomes across different left ventricular ejection fraction cohorts was not well known.

Does baseline LV GLS predict VT/VF or death in heart failure patients stratified by LVEF?

Structured PICO

Does baseline LV GLS predict VT/VF or death in heart failure patients stratified by LVEF?

P

Population

1,077 heart failure patients from the Multicenter Automatic Defibrillator Implantation Trial Cardiac Resynchronization Therapy (MADIT-CRT) with 2D speckle tracking data available (437 patients with LVEF > 30% and 640 with LVEF ≤ 30%).

I

Intervention

Baseline left ventricular global longitudinal strain (LV GLS) assessment, stratified in tertiles.

C

Comparator

Comparison across LV GLS tertiles (T1 vs. T2/3).

O

Outcome

Composite of ventricular tachycardia/fibrillation (VT/VF) or death.composite

Baseline LV GLS is an independent predictor of VT/VF and HF/death in heart failure patients with LVEF ≤ 30%, but its predictive value is not significant in those with LVEF > 30%.

Implication

LV GLS may aid VT/VF risk stratification in LVEF ≤30% HF; hypothesis-generating and requires prospective validation before clinical adoption.

Abstract

BACKGROUND: The predictive value of left ventricular (LV) global longitudinal strain (GLS) to predict outcomes in different left ventricular ejection fraction (LVEF) cohorts is not well known. We aimed to assess the role of LV GLS predicting outcomes in HF patients by LVEF. METHODS: In the Multicenter Automatic Defibrillator Implantation Trial Cardiac Resynchronization Therapy (MADIT-CRT), we studied 1077 patients (59%) with 2D speckle tracking data available, 437 patients with LVEF > 30% and 640 with LVEF ≤ 30%. Baseline LV GLS was stratified in tertiles in both LVEF subgroups. The primary endpoint was ventricular tachycardia/fibrillation (VT/VF) or death; the secondary endpoint was heart failure (HF) or death. RESULTS: In patients with LVEF ≤ 30%, a higher tertile GLS (T3, less contractility) was associated with a higher rate of VT/VF/death (P < 0.001), with similar association in patients with LVEF > 30% (P = 0.057). In patients with LVEF ≤ 30%, a higher tertile GLS was also associated with a higher rate of HF/death. In multivariable models, LV GLS predicted VT/VF or death in the LVEF ≤ 30% subgroup [T1 vs. T2/3 HR = 1.67 (1.16-2.38), P = 0.005], but not in those with LVEF > 30% [T1 vs. T2.3 HR = 1.32 (0.86-2.04), P = 0.21]. LV GLS predicted HF/death in the LVEF ≤ 30% subgroup [T1 vs T2/3 HR = 2.00 (1.30-3.13), P = 0.002], but not in in those with LVEF > 30%. CONCLUSIONS: In this MADIT-CRT sub-study, LV GLS identified patients at higher risk of VT/VF, HF/death risk independently of conventional clinical parameters in patients with LVEF ≤ 30%, but not in patients with LVEF > 30%.