Usefulness of Global Longitudinal Strain to Predict Heart Failure Progression in Patients With Nonobstructive Hypertrophic Cardiomyopathy

Abstract Background Global longitudinal strain has become an alternative to ejection fraction in identifying reduced cardiac function in the left (LV) or right (RV) ventricles. However, these global metrics are not able to characterize patients in which the heart compensates for regional dysfunction. More sensitive metrics are needed to detect subclinical regional dysfunction before cardiac remodeling results in changes in ejection fraction (EF) and global longitudinal strain (GLS). Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to global metrics GLS and LVEF based on modified ACC/AHA Heart Failure Stage that categorized differing levels of structural heart disease for Stage B and C. Methods A single center, prospective registry of MRI scans acquired with a 1.5T scanner were evaluated for conventional CMR diagnostics including biventricular EF, volumes and mass. In addition, fSENC scans were acquired and processed with the MyoStrain software to quantify intramyocardial LV & RV strain. Three short axis scans (basal, midventricular, & apical) were used to calculate strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3- & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. All metrics were compared based on ACC/AHA Heart Failure Stage determined by full CMR exam. Results A total of 977 scans in 779 patients were included in the study; this population included 210 myocarditis, 46 dilated cardiomyopathy, and 30 ischemic cardiomyopathy cases. Patients had an average (± stdev) age of 55 (17) yrs and BMI of 26 (5) kg/m2; 48% had arterial hypertension, 12% diabetes mellitus, 33% valve disease, 24% cancer, 7% atrial fibrillation, 13% pulmonary disease, 5% left bundle branch block, 35% hypercholesterolemia, and 24% coronary artery disease. Figure 1 shows the relationship between segmental strain, calculated as the percent of normal LV segments (longitudinal & circumferential) based on intramyocardial fSENC <−17%, versus LVEF based on ACC/AHA Heart Failure stage. Figure 1 Conclusion Segmental fSENC detects subclinical LV dysfunction well before changes in EF or GLS. Incorporating both longitudinal and circumferential components into segmental fSENC metrics provides an alternative metric that shows consistent changes in heart failure progression irrespective of risk factors or underlying cardiac disease.

Download Full-text

Faculty Opinions recommendation of Global longitudinal strain to predict mortality in patients with acute heart failure.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.733181410.793547947 ◽

2018 ◽

Author(s):

Jerome Fleg

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Longitudinal Strain ◽

Global Longitudinal Strain

Download Full-text

INFLUENCE OF RIGHT VENTRICULAR LEAD IMPLANTATION SITE CHOICE ON PACING EFFICIENCY

International Medical Journal ◽

10.37436/2308-5274-2019-4-3 ◽

2020 ◽

pp. 13-17

Author(s):

Dmitrii Aleksandrovich Lopyn ◽

Stanislav Valerevich Rybchynskyi ◽

Dmitrii Evgenevich Volkov

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Longitudinal Strain ◽

Treatment Options ◽

Global Longitudinal Strain ◽

Optimal Method ◽

Cardiac Stimulation ◽

Ventricular Lead ◽

The Right ◽

Stimulation Of

Currently the electrophysiological treatment options have been considered to be the most effective for many patients with arrhythmogenic cardiomyopathies, as well as in those with arrhythmias on the background of heart failure. Currently, the dependence of efficiency of the pacemakers on the location of the electrodes has been proven. In order to study the effect of a myocardial dysynchrony on the effectiveness of pacing depending on the location of the right ventricular electrode, an investigation has been performed. This study comprised the patients with a complete atrioventricular block, preserved ejection fraction of the left ventricle (more than 50 %), with no history of myocardial infarction, who were implanted with the two−chamber pacemaker. It has been established that the best results were achieved with a stimulation of the middle and lower septal zone of the right ventricle, the worst ones were obtained with a stimulation of its apex. It has been found that the dynamics of the magnitude of segmental strains and a global longitudinal strain coincided with the dynamics of other parameters of the pacemaker effectiveness, which indicated the pathogenetic value of myocardial dysynchrony in the progression of heart failure after implantation of the pacemaker. Therefore it could be concluded that the studying of myocardial mobility by determining a longitudinal strain for assessing the functional state of the myocardium and the effectiveness of pacing is highly advisable. It is emphasized that the use of the latest strains−dependent techniques for cardiac performance evaluation in the patients with bradyarrhythmia have a great potential to predict the development of chronic heart failure and to choose the optimal method of physiological stimulation of the heart. Key words: right ventricular lead, cardiac stimulation, myocardial dyssynchrony.

Download Full-text

Incremental Value of Global Longitudinal Strain in the Long-Term Prediction of Heart Failure among Patients with Coronary Artery Disease

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2021.09.003 ◽

2021 ◽

Author(s):

Kawa Haji ◽

Thomas H. Marwick ◽

Simon Stewart ◽

Melinda Carrington ◽

Yih-Kai Chan ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Term Prediction ◽

Incremental Value ◽

Artery Disease ◽

Long Term Prediction

Download Full-text

Relationship of cardiac troponin to systolic global longitudinal strain in hypertrophic cardiomyopathy

Echocardiography ◽

10.1111/echo.13645 ◽

2017 ◽

Vol 34 (10) ◽

pp. 1470-1477 ◽

Cited By ~ 4

Author(s):

Anushree Agarwal ◽

Rayan Yousefzai ◽

Kambiz Shetabi ◽

Fatima Samad ◽

Saurabh Aggarwal ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Cardiac Troponin ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Relationship Of

Download Full-text

Left Ventricular Global Longitudinal Strain Can Reliably Be Measured from a Single Apical Four-Chamber View in Patients with Heart Failure

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2018.10.009 ◽

2019 ◽

Vol 32 (2) ◽

pp. 317-318 ◽

Cited By ~ 2

Author(s):

Fawaz Alenezi ◽

Andrew P. Ambrosy ◽

Matthew Phelan ◽

Karen Chiswell ◽

Loai Abudaqa ◽

...

Keyword(s):

Heart Failure ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Chamber View ◽

Patients With Heart Failure

Download Full-text

Prognostic Value of Pulmonary Transit Time by Cardiac Magnetic Resonance on Mortality and Heart Failure Hospitalization in Patients With Advanced Heart Failure and Reduced Ejection Fraction

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.120.011680 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Laura Houard ◽

Mihaela S. Amzulescu ◽

Geoffrey Colin ◽

Helene Langet ◽

Sebastian Militaru ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Feature Tracking ◽

Prognostic Value ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Reduced Ejection Fraction ◽

Lv Ejection Fraction ◽

Overall Mortality

Background: Pulmonary transit time (PTT) from first-pass perfusion imaging is a novel parameter to evaluate hemodynamic congestion by cardiac magnetic resonance (cMR). We sought to evaluate the additional prognostic value of PTT in heart failure with reduced ejection fraction over other well-validated predictors of risk including the Meta-Analysis Global Group in Chronic Heart Failure risk score and ischemic cause. Methods: We prospectively followed 410 patients with chronic heart failure with reduced ejection fraction (61±13 years, left ventricular (LV) ejection fraction 24±7%) who underwent a clinical cMR to assess the prognostic value of PTT for a primary endpoint of overall mortality and secondary composite endpoint of cardiovascular death and heart failure hospitalization. Normal reference values of PTT were evaluated in a population of 40 asymptomatic volunteers free of cardiovascular disease. Results PTT was significantly increased in patients with heart failure with reduced ejection fraction as compared to controls (9±6 beats and 7±2 beats, respectively, P <0.001), and correlated not only with New York Heart Association class, cMR–LV and cMR–right ventricular (RV) volumes, cMR-RV and cMR-LV ejection fraction, and feature tracking global longitudinal strain, but also with cardiac output. Over 6-year median follow-up, 182 patients died and 200 reached the secondary endpoint. By multivariate Cox analysis, PTT was an independent and significant predictor of both endpoints after adjustment for Meta-Analysis Global Group in Chronic Heart Failure risk score and ischemic cause. Importantly in multivariable analysis, PTT in beats had significantly higher additional prognostic value to predict not only overall mortality (χ 2 to improve, 12.3; hazard ratio, 1.35 [95% CI, 1.16–1.58]; P <0.001) but also the secondary composite endpoints (χ 2 to improve=20.1; hazard ratio, 1.23 [95% CI, 1.21–1.60]; P <0.001) than cMR-LV ejection fraction, cMR-RV ejection fraction, LV–feature tracking global longitudinal strain, or RV–feature tracking global longitudinal strain. Importantly, PTT was independent and complementary to both pulmonary artery pressure and reduced RV ejection fraction<42% to predict overall mortality and secondary combined endpoints. Conclusions: Despite limitations in temporal resolution, PTT derived from first-pass perfusion imaging provides higher and independent prognostic information in heart failure with reduced ejection fraction than clinical and other cMR parameters, including LV and RV ejection fraction or feature tracking global longitudinal strain. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03969394.

Download Full-text