Prognostic Value of Biventricular Strain in Risk Stratifying in Patients With Acute Heart Failure

Jae‐Hyeong Park; Jin Joo Park; Jun‐Bean Park; Goo‐Yeong Cho

doi:10.1161/jaha.118.009331

September 26, 2018Journal of the American Heart AssociationOpen Access

Prognostic Value of Biventricular Strain in Risk Stratifying in Patients With Acute Heart Failure

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Why the study?

Does biventricular global longitudinal strain predict all-cause mortality in patients with acute heart failure?

Structured PICO

Does biventricular global longitudinal strain predict all-cause mortality in patients with acute heart failure?

P

Population

1824 patients with acute heart failure from a strain registry, mean age 70±14 years, 973 men.

I

Intervention

Measurement of global longitudinal strain (GLS) of both ventricles (LVGLS and RVGLS)

C

Comparator

Comparison between different strain groups (e.g., group 1: ≥9% LVGLS and ≥12% RVGLS vs group 4: <9% LVGLS and <12% RVGLS)

O

Outcome

All-cause mortality at median 31.7 months follow-uphard clinical

In patients with acute heart failure, decreased biventricular global longitudinal strain is independently associated with increased all-cause mortality, particularly in the absence of pulmonary hypertension.

Implication

Biventricular GLS may refine mortality risk stratification in acute HF; leaves open whether it adds value beyond standard measures in prospective cohorts.

Abstract

Background Few studies have shown that right ventricular ( RV ) function is independently related to adverse events regardless of left ventricular ( LV ) function in heart failure. We evaluated the prognostic value of global longitudinal strain ( GLS ) of both ventricles in patients with acute heart failure. Methods and Results We measured biventricular strains in 1824 randomly selected patients (973 men, aged 70±14 years) from a strain registry. A total of 799 patients (43.8%) died during the median follow-up duration of 31.7 months. In univariate analysis, LVGLS and RVGLS were significantly associated with all-cause mortality. We classified them into 4 strain groups according to LVGLS (≥9%) and RVGLS (≥12%). On Cox proportional hazards analysis, group 4 (<9% LVGLS and <12% RVGLS ) had the worst prognosis, with a hazard ratio ( HR ) of 1.755 (95% confidence interval [ CI ], 1.473-2.091; P<0.001) compared with that of group 1 (≥9% LVGLS and ≥12% RVGLS ). After multivariate analysis, both LVGLS (per 1% decrease; HR : 1.057; 95% CI , 1.029-1.086; P<0.001) and RVGLS (per 1% decrease; HR : 1.022; 95% CI , 1.004-1.040; P=0.014) were also significant. The HR of RVGLS <12% was higher in patients without pulmonary hypertension (assessed by maximal tricuspid regurgitation ≤2.8 m/s) after the adjustment of LVGLS ( HR : 1.40 [95% CI , 1.11-1.77] versus 1.07 [95% CI , 0.88-1.30] with pulmonary hypertension; interaction, P=0.043). Conclusions In the patients with acute heart failure, RVGLS was significantly associated with all-cause mortality regardless of LVGLS , and those with decreased biventricular GLS showed the worst prognosis. The predictive power of RVGLS was more prominent in the absence of pulmonary hypertension.