SPC365

Global longitudinal strain as a predictor of cardiovascular events and mortality in patients with ischemic heart disease and heart failure with preserved/mid-range ejection fraction

Session: Posters - B. Imaging
Speaker: João Miguel Santos

Congress: CPC 2021
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Posters
FP Number: ---
Authors: João Miguel Santos; Inês Pires; Vanda Neto; Joana Correia; Luísa Gonçalves; Inês Almeida; Emanuel Correia
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Global longitudinal strain (GLS) is considered a&nbsp;more sensitive marker of systolic dysfunction than other measures commonly used in clinical practice, such as left ventricle ejection fraction (EF). Our objective was&nbsp;to evaluate the impact of reduced GLS in death and cardiovascular events in patients hospitalized due to heart failure with mid-range or preserved ejection fraction, with previous history of acute myocardial infarction.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A retrospective analysis of 170 patients admitted to a Cardiology ward due to acute heart failure (AHF) was performed. Patients with reduced EF (Simpson biplane method - EF&lt;40%) were excluded based on echocardiographic evaluation after AHF stabilization. GLS measured by &ldquo;speckle tracking&rdquo; technique was calculated for each patient. Measurements were made by the same operator to minimize interoperator variability. Mann-Whitney U test was used for univariate analysis. Kaplan-Meier survival plots and Cox-regression analysis were performed to assess differences in 12-month mortality (12MM)&nbsp;and in the composite endpoint of cardiovascular event or death (12CVM) at 12 months. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 127 patients were included. Mean patient age was 64 (&plusmn;14) years; 72% were men. 48% of patients had history of ST elevation AMI. Mean EF was 54% (&plusmn;8) and mean GLS was -14.3 (&plusmn;3.8). Rates of 12MM and 12CVM were 14.2% and 19.3%, respectively. A statistically significant association between 12MM and 12MCV was found in univariate analysis for GLS (<em>p</em>&lt;0.001). Kaplan-Meyer survival plots revealed that a compromised GLS (&lt;-16) was associated with significantly increased 12MM (23% vs 2.5%, <span style="background-color:white"><span style="color:black">X</span></span><sup><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">2 </span></span></span></sup>:7.999, <em>p</em>=0.005) and 12CVM (26.6% vs 10%, <span style="background-color:white"><span style="color:black">X</span></span><sup><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">2 </span></span></span></sup>:4.139, <em>p</em>=0.042). When stratified by mid-range <em>vs</em> preserved EF, GLS &lt;-16 was associated with worse outcomes, although the results did not reach statistical significance (<em>p</em>&gt;0.05). However, when considering a severely compromised GLS (&lt;-13), GLS was significantly associated with increased 12MM (52% vs 8.3%, <span style="background-color:white"><span style="color:black">X</span></span><sup><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">2 </span></span></span></sup>:5.533, <em>p</em>=0.019) and 12CVM (50% vs 8.3%, <span style="background-color:white"><span style="color:black">X</span></span><sup><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">2 </span></span></span></sup>:4.970, <em>p</em>=0.026), in the subgroup of patients with heart failure&nbsp;with mid-range EF. Cox-regression analysis demonstrated that GLS was independently associated with 12MM (HR: 0.668, <em>p</em>&lt;0.001) and the 12CVM composite endpoint (HR: 0.819, <em>p</em>=0.008), even after adjustment for&nbsp;other important prognostic markers such as chronic kidney disease, pulmonary disease and diabetes, with significant hazard ratio reduction for each positive point increase in GLS. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">GLS is an independent predictor of 12MM and 12CVM in patients hospitalized due to&nbsp;AHF, with an EF&ge;40% and previous history of acute myocardial infarction. In the subgroup of patients with heart failure with mid-range EF, a severely compromised GLS (&lt;-13)&nbsp;is a strong predictor of 12MM and 12CVM.</span></span></p>