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Global longitudinal strain: the new left ventricular ejection during an acute coronary syndrome?
Session:
Painel 6-Doença Coronária 1
Speaker:
Carolina Saleiro
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Carolina Saleiro; Diana Decampos; Rogerio Teixeira; Ana Rita M. Gomes; João Lopes; José Pedro Sousa; Luís Puga; Joana M. Ribeiro; Santinha Maria Lurdes Quefi; Marco Costa; Lino Gonçalves
Abstract
<p><strong>Background: </strong>Global longitudinal strain (GLS) is an accurate parameter for the assessment of early left ventricular dysfunction. Previous studies have shown its value in multiple settings, but its role in the prognosis of patients with acute coronary syndromes (ACS) is still warranting validation. </p> <p><strong>Aim: </strong>To assess the role of GLS as a prognostic marker after an ACS.</p> <p><strong>Methods: </strong>Patients admitted to a single coronary care unit with a diagnosis of ACS had their clinical, laboratorial and echocardiographic data evaluated. GLS was retrospectively assessed in a single software, resulting a in a total of 93 patients evaluated. The absolute GLS value |x| was used for a simpler interpretation. The primary endpoint was all-cause mortality. The best GLS cut-off value to predict the outcome was derived from the Youden index and two groups were created: Group A (GLS ≤14.7%) - N=38; and Group B (GLS >14.7%) – N=55. Kaplan-Meyer survival curves and Cox regression were used to evaluate the impact of GLS on the primary outcome. The mean follow-up was 30±14 months</p> <p><strong>Results</strong>: Eighty percent of the patients were male, with a mean age 67±13 years old. 44% had a previous diagnosis of coronary artery disease and the majority (46%) was admitted with non-ST elevation ACS. Sixty-three percent did not have acute heart failure and 55% had a left ventricular ejection fraction (LVEF) ≥ 50%. Mean GLS was 16±4%. Ten patients met the primary endpoint. The area under the curve for GLS was 0.790 (95% CI 0.69-0.87, <em>P<0.001</em>) and the best GLS cut point was 14.7%. Kaplan-Meyer curves showed that patients with more normal GLS had improved survival – GLS ≤14.7% vs GLS >14.7% (48±5% vs 59±1%, Log Rank <em>P=0.002 – Figure 1)</em> for all-cause mortality. In a model adjusted for LVEF (≥50%. vs <50%), GLS is the only variable associated with survival (HR 0.79, 95% CI 0.63-0.96, per each unit increase, <em>P<0.05</em>). In another model, adjusted for acute heart failure, GLS remained the only variable associated with the outcome (HR 0.80, 95% CI 0.66-0.98, per each unit increase, <em>P<0.05</em>).</p> <p><strong>Conclusion: </strong>In our exploratory analysis GLS had a prognostic impact in patients with ACS, regardless of acute heart failure or left ventricular ejection fraction. A GLS cut point of 14.7% had the best discriminatory effect.</p> <p> </p>
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