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Delta global longitudinal strain predicts major cardiovascular events after a first acute coronary syndrome
Session:
Painel 3 - Imagiologia Cardiovascular 1
Speaker:
Pedro Grilo Diogo
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Pedro Grilo Diogo; Carlos Resende; Alzira Nunes; Paulo Araújo; Sofia Torres; Carla De Sousa; Filipe Macedo; Maria Júlia Maciel Barbosa
Abstract
<p>BACKGROUND: Left ventricular ejection fraction (LVEF) is the classic parameter to characterize LV function and predict the occurrence of major adverse cardiac events (MACE) in pts with acute coronary syndrome (ACS). Assessment of LV deformation through quantification of strain by speckle-tracking is a technology with growing implementation in current practice whose prognostic value is increasingly recognized. The prognostic implication of changes in global longitudinal strain (GLS) after a first ACS is less explored.</p> <p>PURPOSE: To evaluate whether LVEF, GLS, change in LVEF and change in GLS are associated with the occurrence of MACE after a first ACS.</p> <p>METHODS: We retrospectively analyzed consecutive pts admitted to our Department with a first ACS between June and December 2016. Routine TTEs were performed between 6 months and 1 year after the ACS. Follow-up data were collected until May 2018. MACE were defined as a composite of cardiovascular (CV) death, hospitalization due to CV causes, repeat ACS, repeat revascularization, and stroke. We collected the initial TTE LVEF (LVEF1) and LVEF at follow-up (LVEF2) and calculated initial GLS (GLS1) and follow-up GLS (GLS2). Change in LVEF (deltaLVEF) and in GLS (deltaGLS) were calculated; positive values describe favourable changes. Descriptive statistics were calculated. Pearson’s correlations compare continuous variables and one-way ANOVA compare variables between pts groups. A multiple linear regression was performed to study the predictive value of LVEF, GLS and delta scores on the occurrence of MACE.</p> <p>RESULTS: We analyzed 32 pts (81% men), whose mean age was 61 years. Mean LVEF1 was 47% (11-68) and mean GLS1 was -14% (-22 to -6,1). At follow-up, the mean LVEF2 was 56% (26-75) and mean GLS2 was -15% (-22,1 to -5,2). Mean deltaLVEF was +10% (-17 to +34) while mean deltaGLS was +1,37% (-6 to +14). There was a strong correlation between LVEF1 and GLS1 (r=-0,73, p<0.001) and LVEF2 and GLS2 (r=-0.82, p<0.001). One-way ANOVAs showed that pts who suffered MACE had significantly lower LVEF1 (35 vs 50, p<0.05), LVEF2 (37 vs 61, p<0.001), worse GLS2 (-9 vs -16, p<0.001) and lower deltaGLS (-2,7 vs +2,3, p<0.05). A stepwise multiple linear regression model showed that LVEF2 and deltaGLS explained 56% of the variance in MACE [R2=0.559, F(2,29)=4,9, p<0.001]. LVEF2 (β=-0.612, p<0.001) and deltaGLS (β=-0.312, p<0.05) significantly predicted the occurrence of MACE.</p> <p>CONCLUSION: In a population of pts after the first ACS, LVEF and GLS were strongly correlated. However, overall positive changes in LVEF were mirrored by only marginal improvement in GLS during follow-up, suggesting that strain reflects persistent mechanical dysfunction unchanged by improvements in LVEF. While LVEF at follow-up predicted the occurrence of MACE, also did deltaGLS, suggesting a prognostic role for the dynamics of GLS after an ACS.</p>
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