Prediction of cardiac events using fully automated GLS and BNP titers in patients with known or suspected heart failure

Figures

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  Fig 1. Step-by step approach to left ventricular (LV) volume and function measurements. A: Manual registration of apical 4-chamber view at end-diastole. B: Automatic LV endocardial border tracing (green line) at end-diastole in apical 4-chamber view. C: 2D speckle tracking analysis throughout the cardiac cycle, and a GLS of 4-chamber view was determined. D: The same procedures on apical 2-chamber view. E: The same procedures on long-axis view. F: Displayed bull’s eye, LV volumes, LV ejection fraction (EF) and global longitudinal strain (GLS).

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  Fig 2. Optimal cut-off values of BNP and GLS, and Kaplan-Meier survival curves for predicting future cardiac death (CD) in the derivation group. Survival CART analysis identified optimal BNP and GLS cut-off values to partition the risk of CD. Colored lines represent the survival curve for CD in each subset, classified using BNP and GLS cut-off values. BNP; B-type natriuretic peptide, GLS; global longitudinal strain, CART; classification and regression trees.

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  Fig 3. Optimal cut-off values of BNP and GLS, and Kaplan-Meier survival curves for predicting major adverse cardiovascular events (MACEs) in the derivation group. Survival CART analysis identified optimal BNP and GLS cut-off values to partition the risk of MACEs. Colored lines represent the survival curve for MACEs in each subset, classified using BNP and GLS cut-off values. BNP; B-type natriuretic peptide, GLS; global longitudinal strain, CART; classification and regression trees.

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  Fig 4. Kaplan−Meier survival analysis for cardiac death (CD; A) and major adverse cardiovascular events (MACEs; B) in the validation group. Each patient was classified into 1 of 3 groups, based upon GLS values from the CART analysis (Fig 4A), while each patient was classified into 1 of 5 groups according to cut-off values for BNP and GLS from the CART analysis (Fig 4B). Colored lines represent survival curves for CD (A) and MACEs (B). BNP; B-type natriuretic peptide, GLS; global longitudinal strain, CART; classification and regression trees.

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  Fig 5. Nested regression model assessing incremental values of blood examination parameters and GLS in the validation group. BNP, sodium, creatinine and hemoglobin afforded significant incremental improvement over the model including age and sex, and LVEF provided significant additional prognostic value over the model including age, sex, BNP, sodium, creatinine and hemoglobin. The further addition of GLS had no incremental value for predicting risk of cardiac death (A) but had a significant incremental value for predicting major adverse cardiovascular events (MACEs; B). BNP; B-type natriuretic peptide, Cre; creatinine, GLS; global longitudinal strain, Hb; hemoglobin, LVEF; left ventricular ejection fraction, Na; sodium.