Key result
Worse LV longitudinal strain linked to ~46% higher risk of adverse cardiac events beyond LVEF.
Why the study?
Chagas cardiomyopathy has a poorer prognosis compared to other cardiomyopathies, and the incremental prognostic value of speckle tracking echocardiography over LVEF is unclear.
Cohort (n=112)
Single-blind
No
Answers are grounded in this paper and cite their sources.
LV longitudinal strain may refine risk stratification beyond LVEF in dilated cardiomyopathy; leaves open whether STE should guide therapy.
BACKGROUND: Chagas cardiomyopathy (CDC) is associated with a poor prognosis compared to other cardiomyopathies. Speckle tracking echocardiography (STE), which provides direct assessment of myocardial fiber deformation, may be useful in predicting prognosis. OBJECTIVE: This study assessed STE in CDC and compared with idiopathic cardiomyopathy (IDC), and also examined the incremental prognostic information of STE over left ventricular ejection fraction (LVEF) in these patients. METHODS: We enrolled 112 patients, age of 56.7 ± 11.8 years, 81 with CDC and 31 with IDC. STE indices were obtained at baseline in all patients. The endpoint was a composite of death, hospitalization for heart failure, or need for heart transplantation. RESULTS: Patients with IDC had worse LV systolic function compared to CDC, with LVEF of 34.5% vs 41.3%, p = 0.004, respectively. After adjustment for LVEF, there were no differences in STE values between CDC and IDC. During a median follow-up of 18.2 months (range, 11 to 22), 26 patients met the composite end point (24%). LV longitudinal strain was a strong predictor of adverse events, incremental to LVEF and E/e' ratio (HR 1.463, 95% CI 1.130-1.894; p = 0.004). The risk of cardiac events increased significantly in patients with GLS > - 12% (log-rank p = 0.035). CONCLUSIONS: STE indices were abnormal in patients with dilated cardiomyopathy, without differences between CDC and IDC. LV longitudinal strain was a powerful predictor of outcome, adding prognostic information beyond that provided by LVEF and E/e' ratio.
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Santos et al. (2019) conducted a cohort in Chagas dilated cardiomyopathy and idiopathic dilated cardiomyopathy (n=112). Left ventricular global longitudinal strain was evaluated on Composite of death, hospitalization for heart failure, or cardiac transplantation (HR 1.463, 95% CI 1.130-1.894, p=0.004). Left ventricular longitudinal strain was a strong predictor of adverse cardiac events, adding incremental prognostic information beyond left ventricular ejection fraction and E/e' ratio (HR 1.463).
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