Association Between Global Longitudinal Strain and Cardiovascular Events in Patients With Left Bundle Branch Block Assessed Using Two-Dimensional Speckle-Tracking Echocardiography - 04/01/18
, Yeonyee E. Yoon, MD a, Jin Joo Park, MD aAbstract |
Background |
The prognostic value of left ventricular (LV) global strain and twist in patients with left bundle branch block (LBBB) is not fully investigated. The aim of this study was to investigate the association between myocardial strain and twist and cardiovascular events in patients with LBBB, as assessed using two-dimensional speckle-tracking echocardiography.
Methods |
A total of 269 patients with LBBB (mean age, 69.5 ± 10.9 years; 46.8% men) were retrospectively identified. Using speckle-tracking, LV global longitudinal strain (GLS), global circumferential strain, and twist were measured. Association between LV global function and a composite of cardiovascular mortality and hospitalization for heart failure was compared with clinical risk factors, LV ejection fraction (LVEF), and other echocardiographic parameters.
Results |
During a median of 27.5 months (interquartile range, 12.8–43.9 months), the composite end point occurred in 55 patients (20.4%). In univariate analyses, diabetes mellitus, chronic kidney disease, ischemic etiology of LBBB, dilated left atrium, reduced LVEF, dilated left ventricle, and impaired LV global strain (GLS > −12.2%, global circumferential strain > −11.8%, and twist < 6.5°) showed associations with the composite end point. In multivariate analyses, GLS was significantly associated with the composite end point (adjusted hazard ratio, 4.697; 95% CI, 1.344–16.413; P = .015), whereas global circumferential strain, twist, and LVEF were not. GLS showed an additive association with poor prognosis over clinical risk factors and other echocardiographic parameters, including LVEF. Patients with preserved LVEFs (≥40%) but impaired GLS (>−12.2%) had a larger number of clinical events than those with impaired LVEFs but preserved GLS.
Conclusions |
Among patients with LBBB, GLS can provide better risk stratification than LVEF or other echocardiographic parameters.
Le texte complet de cet article est disponible en PDF.Highlights |
• | LV GLS is a powerful prognostic factor and detects subtle LV dysfunction. |
• | The authors assessed the association between LV GLS and cardiovascular events in patients with LBBB. |
• | Impaired GLS had a significant association with cardiovascular events in patients with LBBB. |
• | The association between LV GLS and cardiovascular events was significant regardless of LVEF values. |
• | LV GLS may provide better risk stratification than LVEF in patients with LBBB. |
Keywords : Left bundle branch block, Global strain, Speckle-tracking, Global longitudinal strain, Prognosis
Abbreviations : 2D, CKD, CRT, DM, GCS, GLS, HF, HR, IVC, LBBB, LOA, LV, LVEF, NYHA, ROC, STE
Plan
| Conflicts of Interest: None. |
Vol 31 - N° 1
P. 52 - janvier 2018 Retour au numéro
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