scholarly journals Mechanical Dispersion as a powerful echocardiographic predictor of outcomes after Myocardial Infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P De Sousa Bispo ◽  
P Azevedo ◽  
P Freitas ◽  
N Marques ◽  
C Reis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Survival Analysis ◽  
Primary Endpoint ◽  
Longitudinal Strain ◽  
Univariate Analysis ◽  
Global Longitudinal Strain ◽  
P Value ◽  
Peak Strain ◽  
Kaplan Meier

Abstract Introduction Several studies have addressed the importance of transthoracic echocardiography (TTE) in risk prediction of subsequent adverse events after ST elevation myocardial infarction (STEMI). While several traditional echo parameters have a well-established prognostic value, data derived from 2D-Speckle Tracking Echocardiography (2DSTE) needs further investigation. Objectives To determine if 2DSTE parameters provide additional information beyond conventional echocardiography to predict long-term adverse outcomes in patients admitted with STEMI Methods Retrospective, single-center study, that included all patients without previous cardiovascular events admitted with STEMI (who underwent primary coronary angioplasty) between 2015 and 2017. Patients with poor acoustic windows, severe valvular disease, irregular heart rhythm, and those who died during hospital stay were excluded. We reviewed all pre-discharge TTE to assess conventional parameters of LV systolic and diastolic function and data obtained by 2DSTE: global longitudinal strain (GLS) and peak strain dispersion (PSD), an index that is the standard deviation from time to peak strain of all segments over the entire cardiac cycle. Demographic and clinical data was obtained through electronic hospital records. Minimum follow-up was 2 years. The primary endpoint was a composite of all-cause mortality and cardiovascular re-admission at follow-up. Survival analysis was used to determine independent predictors of the primary endpoint. Results 377 patients were included, mean age 62±13 years, 72% male. Mean LVEF was 50±10% with 19% of patients having LVEF <40%. Mean indexed left atrium volume (LAVi) was 33±10 ml/m2, mean GLS was −14±4%, and PSD was 60±22 msec. Average follow-up was 36±11 months, with a combined endpoint of mortality and hospitalization of 27% (n=102) Univariate analysis of echocardiographic variables revealed an association between heart rate, LVEF, indexed LV end-systolic volume, indexed stroke volume, LAVi, GLS and PSD with the endpoint. However, on multivariate analysis only LAVi [HR 1.030 (95% CI 1.009 - 1.051), p-value = 0.005] and PSD [HR 1.011 (95% CI 1.002 - 1.020), p-value = 0.012] remained independent predictors of the primary endpoint. We determined that a PSD value higher than 52 msec has a sensitivity of 76% and a negative predictive value of 83% for mortality and hospitalization, and that this cut-off point discriminates patients at a higher risk of events in Kaplan-Meier Survival analysis with a Log-Rank p-value=0.001. Conclusion PSD derived by longitudinal strain analysis is a promising prognostic predictor after STEMI. PSD outperformed conventional echocardiographic parameters in the risk stratification of STEMI patients at discharge. Kaplan-Meier Survival Curves Funding Acknowledgement Type of funding source: None

scholarly journals Correlation of Triiodothyronine Level with In-Hospital Cardiac Function and Long-Term Prognosis in Patients with Acute Myocardial Infarction

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Jianqing She ◽  
Jiahao Feng ◽  
Yangyang Deng ◽  
Lizhe Sun ◽  
Yue Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Survival Analysis ◽  
Cardiac Function ◽  
Thyroid Function ◽  
Major Adverse Cardiovascular Events ◽  
Free Triiodothyronine ◽  
Kaplan Meier ◽  
Significant Difference

Objective. The pathophysiologic mechanism of how thyroid function is related to the development and prognosis of acute myocardial infarction (AMI) remains under explored, and there has been a lack of clinical investigations. In this study, we investigate the relationship between triiodothyronine (T3) level and cardiac ejection fraction (EF) as well as probrain natriuretic peptide (NT-proBNP) on admission and subsequent prognosis in AMI patients. Methods. We measured admission thyroid function, NT-proBNP, and EF by echocardiography in 345 patients diagnosed with AMI. Simple and multiregression analyses were performed to investigate the correlation between T3 level and EF as well as NT-proBNP. Major adverse cardiovascular events (MACE), including new-onset myocardial infarction, acute heart failure, and cardiac death, were documented during the follow-up. 248 participants were separated into three groups based on T3 and free triiodothyronine (FT3) levels for survival analysis during a 2-year follow-up. Results. 345 patients diagnosed with AMI were included in the initial observational analysis. 248 AMI patients were included in the follow-up survival analysis. The T3 levels were found to be significantly positively correlated with EF (R square=0.042, P<0.001) and negatively correlated with admission NT-proBNP levels (R square=0.059, P<0.001), which is the same with the correlation between FT3 and EF (R square=0.053, P<0.001) and admission NT-proBNP levels (R square=0.108, P<0.001). Kaplan-Meier survival analysis revealed no significant difference with regard to different T3 or FT3 levels at the end of follow-up. Conclusions. T3 and FT3 levels are moderately positively correlated with cardiac function on admission in AMI patients but did not predict a long-time survival rate. Further studies are needed to explain whether longer-term follow-up would further identify the prognosis effect of T3 on MACE and all-cause mortality.

P1018Evolution of atrioventricular conduction disorders after TAVI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Irles ◽  
F Salerno ◽  
R Cassagneau ◽  
R Eschallier ◽  
C Maupain ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Primary Endpoint ◽  
Univariate Analysis ◽  
P Value ◽  
Conduction Disorders ◽  
Av Conduction ◽  
One Year ◽  
The One ◽  
Valve Implantation

Abstract Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (TAVI) is poorly understood, and indications of pacemaker (PM) implantation after TAVI not well defined. Modern PM algorithms can help studying the evolution of these AV conduction disorders after TAVI. SafeR® mode (Sorin® PM) allows to monitor precisely the AV conduction and to store AVB episodes in the PM memory as intracardiac electrograms, which can be re-read and validated afterwards. Methods From November 2015 and January 2017, all patients implanted in one of the 19 French enrolling centers with a Sorin® PM set in SafeR® mode after TAVI could be prospectively included in the study. All the PM interrogation files were centrally collected. The primary endpoint (PE) was the presence of at least one episode of high grade AVB (HG-AVB) beyond day 7 (D7) to one year after the TAVI. It could be validated either by the presence of a HG-AVB on EKG or telemetry, or by the confirmation of a HG-AVB in the PM memory files. Results 273 patients were included in the study, the PE was assessable in 197 patients. PE was validated in 74.6% patients. In univariate analysis, the use of an oversized prothesis or balloon, and all early episodes of HG-AVB (all those occurring up to D7) influence the validation of the PE. Other AV conduction disorders have no influence on the PE (Table). In multivariate analysis, only HG-AVB occurring between D2 and D7 has a significant influence on the PE. Factors influencing HG-AVB after TAVI Studied factor HG-AVB episode(s) during the one year follow up No HG-AVB episode during the one year follow up p value RBBB before TAVI (%) 41 34 0,346 Low implantation (>6mm) (%) 59 37 0,156 Use of Autoexpansive Valve (%) 62 62 0,990 Oversizing (%) 19 6 0,022 HG-AVB per TAVI (%) 56 30 0,001 HG-AVB D0-D1 (%) 53 24 0,001 HG-AVB D2-D7 (%) 68 34 0,001 New or wiser LBBB and improvement of PR interval after TAVI (%) 30 39 0,253 Influence of predefined factors on the Primary Endpoint. Conclusion The analysis of the SafeR® algorithm files in patients implanted with a PM after TAVI show a high incidence of HG-AVB during the one year follow up. In multivariate analysis, only HG-AVB occurring between D2 and D7 significantly influence the PE, confirming that AV conduction disorders occurring during the first 24 hours may spontaneously normalize. Acknowledgement/Funding Microport CRM

P1951Serial left ventricular global longitudinal strain and mortality in patients with Takotsubo cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Isaza ◽  
A Alashi ◽  
J Faulx ◽  
Z B Popovic ◽  
V Menon ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Takotsubo Cardiomyopathy ◽  
Longitudinal Strain ◽  
Troponin I ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Rank Statistic ◽  
Benign Condition ◽  
Kaplan Meier

Abstract Background Recent studies on Takotsubo cardiomyopathy (TC) have challenged the common conception that it is a relatively benign condition with functional recovery observed in the majority of cases. However, it is important to recognize that overt functional recovery might not reflect the true regional recovery, which might have an adverse impact on survival. Objective We sought to assess baseline and follow-up left ventricular function characteristics and their impact on longer-term mortality in patients presenting with documented Takotsubo cardiomyopathy (TC) at a tertiary centre. Methods 339 patients (66±14 years, 88% women) presented to our centre between 2006 and 2018 with acute anginal symptoms and were subsequently diagnosed with TC following clinical and angiographic evaluation. All patients returned for a follow-up evaluation including transthoracic echocardiography (TTE). Baseline and follow-up (3–6 months after TC diagnosis) LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS using velocity vector imaging) were recorded on TTE. The primary endpoint was longer-term mortality. Results Hypertension, dyslipidaemia, and diabetes were present in 71%, 56%, and 26% of patients. Baseline mean troponin I peak, LVEF and LV-GLS were 0.9±7 ng/ml, 36±9%, and 11±3%; respectively. 94% had baseline LVEF<50%, 272 (80%) had apical ballooning, and 94% had LV-GLS worse than −18%. No patient had angiographically obstructive coronary artery disease. At 3–6 months follow-up, mean LVEF, and LV-GLS improved to 57±9% and 16±3%, respectively. 87% of patients had LVEF >50%, but in 70% LV-GLS remained worse than −18%. After 3.3±3 years, 72 patients (21%) died. On multivariable Cox survival analysis (adjusted for age, gender, baseline troponin peak and follow up LVEF), follow up LV-GLS was independently associated with longer-term mortality (hazard ratio 1.12 [95% confidence interval 1.05, 1.20], p<0.001). Significantly more patients with follow up LV-GLS worse than −18% died vs. those with LV-GLS better than −18% (57/237 [24%] vs. 15/102 [15%], log-rank statistic p-value 0.01, Kaplan-Meier figure 1). Kaplan-Meier curve of freedom from death Conclusions In this large single-centre study of patients with documented TC (majority women), 87% recovered LVEF at 3–6 months, but in 70% LV-GLS remained worse than −18%, which was independently associated with higher longer-term mortality.

P4631Eosinopenia an inflammatory marker of adverse clinical outcomes in patients presenting with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Alkhalil ◽  
A K Kearney ◽  
M H Hegarty ◽  
C S Stewart ◽  
P D Devlin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Eosinophil Count ◽  
Systolic Function ◽  
P Value ◽  
Diabetic Patients

Abstract Background Inflammation is an indicator of worse clinical outcomes following acute myocardial infarction. Eosinopenia was identified as a surrogate of inflammation in sepsis and obstructive airway disease. Whether this readily-available marker has any impact on long term outcomes following ST-segment elevation myocardial infarction (STEMI) is yet to be determined. Purpose We sought to study the incidence and relationship between eosinopenia and infarct severity and whether low eosinophil had impact on clinical outcomes following STEMI. Methods 606 consecutive STEMI patients undergoing primary PCI from a large volume single centre were enrolled. Low eosinophil count was defined as <40 cells/ml from samples within 2 -hours post reperfusion. Primary endpoint was defined as composite of death, MI, stroke, unplanned revascularisation, re-admission for heart failure over 3.5 years follow up. Results 65% of patients had eosinopenia. Patients in the low eosinophil group had larger infarct size as measured by troponin value [2934 vs. 1177ng/L, P<0.001] and left ventricle (LV) systolic function on echocardiography [48% vs. 50%, P=0.029]. Thehre was a modest correlation between eosinophil count and both troponin (r=−0.25, P<0.001) and ejection fraction (r=0.10, P=0.017). The primary endpoint was higher in eosinopenic patients (28.8% vs. 20.4%, HR 1.49, 95% CI 1.05 to 2.13, P=0.023) (Figure). The difference was mainly driven from higher percentage of unplanned revascularisations (8.2% versus 2.9%, P=0.012) (Table). Low eosinophil count was an independent predictor of adverse cardiovascular events, beyond infarct severity, in elderly, non-diabetic patients (HR 2.04, 95% CI 1.04 to 4.01, P=0.038). Incidence rate of major clinical Clinical characteristics Low eosinophil Normal eosinophil P value Long term clinical events 28.8% (112) 20.4% (42) 0.026 Long term mortality 14.1% (55) 11.1% (23) 0.31 Long term MI 6.9% (27) 4.9% (10) 0.32 Long term unplanned revascularisation 8.2% (32) 2.9% (6) 0.012 Long term re-admission CCF 6.7% (26) 4.9% (10) 0.37 Long term stroke 2.6% (10) 1% (2) 0.19 Conclusions Eosinopenia is a readily-available marker which was associated with a larger infarcts and worse clinical outcomes over long term follow up.

scholarly journals Assessment of global longitudinal strain and plasma natriuretic peptide in patients with asymptomatic left ventricular dysfunction

Kardiologiia ◽  
2021 ◽  
Vol 61 (10) ◽  
pp. 53-60
Author(s):  
Ganchimeg Ulziisaikhan ◽  
Mungun-Ulzii Khurelbaatar ◽  
Chingerel Khorloo ◽  
Naranchimeg Sodovsuren ◽  
Altaisaikhan Khasag ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Roc Curve ◽  
Longitudinal Strain ◽  
Troponin I ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Systolic Function

Objective    The purpose of this study was to investigate the association between global longitudinal strain (GLS) and plasma NT-proBNP for predicting left ventricular (LV) performance in asymptomatic patients after acute myocardial infarction (AMI).Material and methods    We prospectively included patients with diagnosis of AMI without clinical signs and symptoms of heart failure (HF) and followed these patients for 6 mos. Baseline echocardiography was performed at admission, and follow-up echocardiography was performed after 6 mos. A normal GLS was defined as having an absolute value of ≥16 %. According to the baseline GLS, participants were divided into two groups and compared. In all participants, blood samples of plasma NT-proBNP were obtained at admission, before discharge, and 6 mo after discharge.Results    The study population was consisted of 98 participants, of which 80 (81.6 %) were males, and the mean age was 56.0±9.3 years. Baseline echocardiography showed that most of the participants (60, 61.2 %) had abnormal GLS<16 %, whereas 38 (38.8 %) participants had normal or borderline GLS ≥16 %. Compared with the normal GLS group, participants with abnormal GLS had higher GRACE score, higher troponin I concentration, lower systolic blood pressure, lower mean LV ejection fraction, and decreased LV diastolic function. At 6‑mo follow-up, only LV systolic function remained significantly different between the two groups. Compared to baseline, there was a significant improvement of GLS in the abnormal GLS group at 6‑mo follow-up (p=0.04). Prevalence of complications after AMI was significantly higher in this group. There were significant differences between baseline and discharge NT-proBNP concentrations between the two groups (p<0.05). In the abnormal GLS group, there were significant correlations between baseline and discharge NT-proBNP concentrations with baseline LV systolic function. Discharge NT-proBNP concentration also correlated significantly with 6‑mo follow-up GLS. For determining the effect of baseline GLS abnormality, the areas under the ROC curve for baseline and discharge NT-proBNP concentrations were 0.73 (95 % CI 0.60–0.85, p=0.001) and 0.77 (95 % CI 0.66–0.87, p<0.001), respectively. Regarding early prediction of follow-up GLS abnormality, the area under the ROC curve for discharge NT-proBNP concentration was significantly higher 0.70 (95 % CI 0.55–0.84, p=0.016). The optimum cut-off value of discharge NT-pro-BNP was 688.5 pg / ml, with 72.4 % sensitivity and 65.4 % specificity to predict 6‑mon GLS abnormality following acute myocardial infarction.Conclusion    The main finding of this study is that impaired LV GLS is associated with elevated plasma concentrations of NT-proBNP in post-AMI patients. Pre-discharge NT-proBNP concentration combined with impaired initial GLS could predict worsening LV systolic function over time in asymptomatic post-AMI patients.

Relationship between regional left ventricular dysfunction and cancer-therapy-related cardiac dysfunction

Heart ◽  
2020 ◽  
Vol 106 (22) ◽  
pp. 1752-1758 ◽  
Author(s):  
Yoshihito Saijo ◽  
Kenya Kusunose ◽  
Yuichiro Okushi ◽  
Hirotsugu Yamada ◽  
Hiroaki Toba ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Longitudinal Strain ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Kaplan Meier ◽  
The Difference ◽  
Risk Of Cancer

ObjectiveThe aim of our study was to assess the association between risk of cancer-therapy-related cardiac dysfunction (CTRCD) after first follow-up and the difference in echocardiographic measures from baseline to follow-up.MethodsWe retrospectively enrolled 87 consecutive patients (58±14 years, 55 women) who received anthracycline and underwent echocardiographic examinations both before (baseline) and after initial anthracycline administration (first follow-up). We measured absolute values of global longitudinal strain (GLS), apical longitudinal strain (LS), mid-LS and basal-LS at baseline and first follow-up, and per cent changes (Δ) of these parameters were calculated. Among 61 patients who underwent further echocardiographic examinations (second follow-up, third follow-up, etc), we assessed the association between regional left ventricular (LV) systolic dysfunction from baseline to follow-up and development of CTRCD, defined as LV ejection fraction (LVEF) under 53% and more absolute decrease of 10% from baseline, after first follow-up.ResultsLVEF (65%±4% vs 63±4%, p=0.004), GLS (23.2%±2.6% vs 22.2±2.4%, p=0.005) and basal-LS (21.9%±2.5% vs 19.9±2.4%, p<0.001) at first follow-up significantly decreased compared with baseline. Among the 61 patients who had further follow-up echocardiographic examinations, 13% developed CTRCD. In the Cox-hazard model, worse Δbasal-LS was significantly associated with CTRCD. By Kaplan–Meier analysis, patients with Δbasal-LS decrease of more than the median value (−9.7%) had significantly worse event-free survival than those with a smaller decrease (p=0.015).ConclusionsBasal-LS significantly decreased prior to development of CTRCD, and worse basal-LS was associated with development of CTRCD in patients receiving anthracycline chemotherapy.

scholarly journals Prognostic impact of non-improvement of global longitudinal strain in patients with revascularized acute myocardial infarction

2021 ◽  
Author(s):  
Jan Erik Otterstad ◽  
Ingvild Billehaug Norum ◽  
Vidar Ruddox ◽  
An Chau Maria Le ◽  
Bjørn Bendz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Longitudinal Strain ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Ventricular Ejection Fraction

AbstractGlobal longitudinal strain (GLS) is a more sensitive prognostic factor than left ventricular ejection fraction (LVEF) in various cardiac diseases. Little is known about the clinical impact of GLS changes after acute myocardial infarction (AMI). The present study aimed to explore if non-improvement of GLS after 3 months was associated with higher risk of subsequent composite cardiovascular events (CCVE). Patients with AMI were consecutively included at a secondary care center in Norway between April 2016 and July 2018 within 4 days following percutaneous coronary intervention. Echocardiography was performed at baseline and after 3 months. Patients were categorized with non-improvement (0 to − 100%) or improvement (0 to 100%) in GLS relative to the baseline value. Among 214 patients with mean age 65 (± 10) years and mean LVEF 50% (± 8) at baseline, 50 (23%) had non-improvement (GLS: − 16.0% (± 3.7) to − 14.2% (± 3.6)) and 164 (77%) had improvement (GLS: − 14.0% (± 3.0) to − 16.9% (± 3.0%)). During a mean follow-up of 3.3 years (95% CI 3.2 to 3.4) 77 CCVE occurred in 52 patients. In adjusted Cox regression analyses, baseline GLS was associated with all recurrent CCVE (HR 1.1, 95% CI 1.0 to 1.2, p < 0.001) whereas non-improvement versus improvement over 3 months follow-up was not. Baseline GLS was significantly associated with the number of CCVE in revascularized AMI patients whereas non-improvement of GLS after 3 months was not. Further large-scale studies are needed before repeated GLS measurements may be recommended in clinical practice.Trial registration: Current Research information system in Norway (CRISTIN). Id: 506563

P4377Use of LV Deformation Imaging to predict long term Heart Failure Risk in high risk patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Haji ◽  
T Marwick ◽  
C Neil ◽  
S Stewart ◽  
M Carrington ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
P Value ◽  
Ageing Population ◽  
Patients At Risk

Abstract Background The increasing prevalence of heart failure (HF), due to hypertension, ischaemic heart disease, diabetes, obesity, and ageing population demands identification of at-risk subgroup whom we could target on prevention strategies. In a same cohort of patients at risk of HF (70% with CAD), 13% developed new HF hospitalization or death over 4.3 years of follow-up, however, disease management program did not confer any benefit to outcome and LV ejection fraction (EF) was not predictive of progression to HF. Better risk stratification strategies are needed. In this study, we sought whether advanced echo measure on deformation, global longitudinal strain (GLS) would predict HF admission over a long term follow up and thereby define an at-risk group. Aim: To determine which of the LV morphology, function and deformation parameters, best predict new HF admission or HF death in pts at risk but without prior dx of HF. Method Echocardiograms (including measurement of LV, size, function, morphology and deformation) were obtained in 431 inpatients (mean age 65±11, 72% male) at risk of HF. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured offline (EchoPac, GE). Long term (9 years) follow up data were obtained via data linkage. Results 63 pts (15%) reached the end-point of HF admission or HF death. LV deformation showed a univariable association with outcome (Table). In multivariable analysis, including known significant predictors of outcome (age, sex, BMI, diabetes, hypertension), GLS less than 18 remained an independent predictor (Table), in addition to age and DM at baseline. EF and LV mass were not predictors of heart failure. HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Age 1.1 (1–1.1) <0.01 1.1 (1–1.1) 0.04 1 (1–1.1) 0.04 Sex 1.0 (0.6–1.7) 0.9 0.8 (0.4–1.8) 0.6 0.8 (0.4–1.8) 0.6 BMI 1.0 (1–1.1) 0.05 1 (0.9–1.1) 0.7 1 (0.9–1.1) 0.7 DM 2.6 (1.6–4.3) <0.01 2.7 (1.4–5.3) <0.01 2.7 (1.4–5.2) 0.04 LVMI 1.0 (1.0–1.0) <0.01 1 (0.9–1.0) 0.7 1 (0.99–1.0) 0.7 Impaired EF, % 1.0 (0.9–1.0) <0.01 1 (0.9–1.0) 0.16 0.97 (0.94–1.0) 0.04 Diastolic dysfunction 2.3 (1.4–3.7) <0.01 0.8 (0.3–1.7) 0.5 0.7 (0.3–1.7) 0.5 GLS 1.3 (1.4–1.2) <0.01 1.1 (1–1.2) 0.07 GLS <18 5.3 (2.8–10.2) <0.01 2.3 (1.1–5.1) 0.04 Conclusion GLS <18 is independently associated with increasing new onset heart failure admission and HF mortality in patients at risk of HF.

6067Right ventricular global longitudinal strain predicts cardiovascular mortality and heart failure hospitalization in patients with functional tricuspid regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Ochoa-Jimenez ◽  
A C Guta ◽  
M Previtero ◽  
C Palermo ◽  
P Aruta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Tricuspid Regurgitation ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Composite Outcome ◽  
Basal Diameter ◽  
Functional Tricuspid Regurgitation ◽  
Kaplan Meier ◽  
Primary Composite Outcome

Abstract Background Functional tricuspid regurgitation (FTR) and its increasing severity are well-known factors associated with increased morbidity and mortality in patients with pulmonary artery hypertension or left heart diseases. Purpose To assess the main clinical and echocardiographic determinants of outcome in patients with various causes of FTR. Methods A total of 140 patients (pts) (72±14 years, 40% men) with FTR of diverse etiologies underwent complete 2D and additional 3D echocardiography acquisitions and were followed for a median of 5.2 years (interquartile range 2.1 - 6.7 years). Severe FTR was defined by ≥2 parameters: (1) coaptation defect; (2) vena contract ≥7; (3) PISA radius >9 mm; (4) hepatic vein systolic flow reversal. The primary composite outcome was defined as death from cardiovascular causes and hospitalization due to right-sided heart failure (HF). Results 74 pts (53%) developed the primary composite outcome. Death occurred in 31 pts (22%), while hospitalization due to right-sided HF occurred in 66 pts (47%). At baseline, patients who developed the primary composite outcome, compared to those who did not, had more symptoms, more severe FTR, higher pulmonary systolic pressure (60±27 vs 43±16 mmHg), larger right atrium (69±34 vs 51±22 mL/mm2), right ventricular (RV) basal diameter (29±6 vs 24±4 mm/m2), larger RV end-diastolic (102±45 vs 76±25 mL/m2) and end-systolic (62±37 vs 43±17 mL/m2) volumes, larger tricuspid annulus area (7.7±1.8 vs 6.8±1.8 cm2/m2), lower RV systolic function (RVEF [42±11 vs 46±8%], TAPSE [18±4 vs 21±4], S' [11±3 vs 12±2], RV global longitudinal strain (RVGLS) [16±5 vs 19±4], RV free wall longitudinal strain [19±7 vs 23.5]); all p-values <0.03. There were no significant differences in age, body size or comorbidities. After multivariable Cox regression analysis, FTR grade severity (hazard ratio [HR]=2.95, 95% confidence interval [CI] 2.14–4.06, p<0.001) and RVGLS (HR= 0.91, 95% CI 0.86–0.95) were the only independent predictors of mortality. A cutoff of −17.5 for RVGLS had 57% sensitivity, 73% specificity and a HR of 2.34 (95% CI of 1.42–3.88, p-value=0.001). The Kaplan Meier survival curve showed that patients with an RVGLS ≥ −17.5 had a higher probability of developing the primary composite outcome, especially at an earlier phase of the follow up when compared to those with higher LS (log rank test chi-square = 13.0, p<0.001) (Figure). At the end of follow up, 60% of patients with a RVGLS ≥-17.5 did not developed the primary composite outcome vs 29% in the group with a LS lower than −17.5. Kaplan-Meier curve of outcome by RVGLS Conclusions In patients with FTR, a decreased RVGLS, with a cutoff of −17.5, proved to be an independent prognostic factor for the development of HF hospitalizations and death from cardiovascular causes.

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