Key result
Global longitudinal strain less negative than -7.5% was associated with a 3.75-fold higher risk of 12-month all-cause mortality and readmission in patients with heart failure with reduced ejection fraction.
Why the study?
The prognostic value of LVEF is inconsistent compared with LV strain, which can detect early heart failure and predict readmission and death.
Does left ventricular global longitudinal strain predict 12-month readmission or death better than conventional parameters in patients with HFrEF?
Cohort (n=67)
No
Does left ventricular global longitudinal strain predict 12-month readmission or death better than conventional parameters in patients with HFrEF?
Hazard Ratio: 3.75
p-value: p=0.003
Global longitudinal strain is a strong, independent predictor of 12-month readmission and death in HFrEF patients, outperforming conventional LVEF.
GLS/GCS may detect early HF and predict readmission better than LVEF; leaves open prospective validation before guiding care.
Background: Heart failure (HF) is a severe clinical syndrome caused by diversed etiologies. Classically left ventricle ejection fraction (LVEF) has been used as a diagnostic marker as well as to subdivide HF into 3 groups (HFpEF, HFmEF and HFrEF). However, the prognostic value of this index is not consistent in comparison to LV strain (GLS, GCS) which are not only able to detect heart failure at a very early stage (precede to EF change) but also to predict the primary outcome including HF readmission and death. The prognostic role of LV strain is independent and incremental to conventional echocardiographic parameters. Methods: 67 patients diagnosed with chronic HFrEF (EF < 40%) in Vietnam National Heart Institute were consecutively enrolled in our study from January 2016 to September 2016. Clinical data were comprehensively evaluated and conventional echocardiographic parameters and two LV strain indices (GLS & GCS) were measured using speckle-tracking. All patients were followed-up for all-cause 12-month readmission or death after discharge. The relation between echocardiographic parameters and clinical events was analyzed in Cox proportional hazard model. Results: GLS had a prognostic value of composite events after being adjusted with age, sex, heart rate, SBP, DBP, NT-ProBNP, renal clearance, LVEF and LVDd. GLS (cut-off = -7.5%; AUC = 0.738; p = 0.003) was a stronger predictor of composite event compared to LVEF (AUC= 0.66, p = 0.042) LVDd (AUC = 0.637; p = 0.025), LA diameter (AUC = 0.614, p = 0.03), NT-ProBNP (AUC = 0.663; p = 0.04) and hs-Troponin T (AUC = 0.592; p = 0.039). Conclusion: Global longitudinal strain is and strong and independent predictor of readmission and death in patients with heart failure with reduced ejection fraction.
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Nguyen et al. (2023) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=67). Global longitudinal strain (GLS) vs. GLS more negative than -7.5% was evaluated on Composite of 12-month all-cause death or readmission (HR 3.75, p=0.003). Global longitudinal strain less negative than -7.5% was associated with a 3.75-fold higher risk of 12-month all-cause mortality and readmission in patients with heart failure with reduced ejection fraction.
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