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. 2014 Dec;16(12):1301-9.
doi: 10.1002/ejhf.154. Epub 2014 Sep 11.

Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort

Cesare Russo  1 , Zhezhen Jin, Mitchell S V Elkind, Tatjana Rundek, Shunichi Homma, Ralph L Sacco, Marco R Di Tullio
Affiliations

Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort

Cesare Russo et al. Eur J Heart Fail. 2014 Dec.

Abstract

Aims: Global longitudinal strain (GLS) assessed by speckle-tracking echocardiography has been proposed as a parameter able to reflect early changes in left ventricular systolic function at a stage when left ventricular ejection fraction (LVEF) is still normal. This study aimed at assessing prevalence and prognostic value of left ventricular systolic dysfunction (LVSD) assessed by echocardiographic speckle-tracking GLS in a community-based cohort.

Methods and results: Participants from the community-based prospective Northern Manhattan Study underwent two-dimensional transthoracic echocardiography as part of the Cardiovascular Abnormalities and Brain Lesions study. Left ventricular systolic function was assessed by LVEF and speckle-tracking GLS. Subjects were followed annually (mean = 4.8 ± 1.5 years) and incident vascular events (ischaemic stroke, myocardial infarction, and vascular death) were reviewed and adjudicated. Of the 708 study participants, 114 (16.1%) had abnormal GLS but normal LVEF (GLS-LVSD), 30 (4.2%) had abnormal LVEF (LVEF-LVSD), and 564 (79.7%) had normal GLS and LVEF (no-LVSD). In multivariate analysis, risk of events was significantly greater in GLS-LVSD [adjusted hazard ratio (HR) = 2.39, 95% confidence interval (CI) = 1.20-4.77] and in LVEF-LVSD (adjusted HR = 3.51, 95% CI = 1.25-9.88) compared with no-LVSD. Among participants with normal LVEF, lower GLS was significantly associated with events (adjusted HR/unit decrease = 1.15, 95% CI = 1.03-1.28) whereas LVEF was not (adjusted HR/unit decrease = 1.01, 95% CI = 0.94-1.07). The GLS prognostic value was incremental to risk factors and LVEF both in the overall population (chi-square change = 7.406, P = 0.006) and in participants with normal LVEF (chi-square change = 6.357, P = 0.012).

Conclusion: In a community-based cohort, GLS-LVSD was four times more frequent than LVEF-LVSD. GLS-LVSD was a powerful and independent predictor of cardiovascular events. Left ventricular function assessment by GLS may improve cardiovascular risk stratification in subjects with normal LVEF.

Keywords: Ejection fraction; Global longitudinal strain; Left ventricular systolic dysfunction; Outcome.

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Conflict of interest statement

CONFLICT OF INTEREST: None declared.

Figures

Figure 1
Figure 1
Flow diagram showing selection of the present study population from the original CABL cohort.
Figure 2
Figure 2
Prevalence of LVSD by age.
Figure 3A
Figure 3A
Kaplan-Meier plot comparing event-free probability in participants with any LVSD vs. no LVSD.
Figure 3B
Figure 3B
Kaplan-Meier plot comparing event-free probability in participants with LVEF-LVSD, GLS-LVSD, and no LVSD.
See this image and copyright information in PMC

Comment in

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