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. 2016 Mar;3(1):17-24.
doi: 10.1530/ERP-15-0037. Epub 2016 Feb 23.

Prognostic utility of blood pressure-adjusted global and basal systolic longitudinal strain

Isaac B Rhea  1 , Shuja Rehman  2 , Upasana Jarori  3 , Muhammad W Choudhry  4 , Harvey Feigenbaum  5 , Stephen G Sawada  3
Affiliations

Prognostic utility of blood pressure-adjusted global and basal systolic longitudinal strain

Isaac B Rhea et al. Echo Res Pract. 2016 Mar.

Abstract

Assessment of global longitudinal systolic strain (GLS) and longitudinal systolic strain of the basal segments (BLS) has shown prognostic value in cardiac disorders. However, strain is reduced with increased afterload. We assessed the prognostic value of GLS and BLS adjusted for afterload. GLS and BLS were determined in 272 subjects with normal ejection fraction and no known coronary disease, or significant valve disease. Systolic blood pressure (SP) and diastolic blood pressure (DP) obtained at the time of echocardiography were used to adjust GLS and BLS as follows: strain×SP (mmHg)/120 mmHg and strain×DP (mmHg)/80 mmHg. Patients were followed for cardiac events and mortality. The mean age was 53±15 years and 53% had hypertension. There were 19 cardiac events and 70 deaths over a mean follow-up of 26±14 months. Cox analysis showed that left ventricular mass index (P=0.001), BLS (P<0.001), and DP-adjusted BLS (P<0.001) were independent predictors of cardiac events. DP-adjusted BLS added incremental value (P<0.001) to the other two predictors and had an area under the curve of 0.838 for events. DP (P=0.001), age (P=0.001), ACE inhibitor use (P=0.017), and SP-adjusted BLS (P=0.012) were independent predictors of mortality. SP-adjusted BLS added incremental value (P=0.014) to the other independent predictors. In conclusion, DP-adjusted BLS and SP-adjusted BLS were independent predictors of cardiac events and mortality, respectively. Blood pressure-adjusted strain added incremental prognostic value to other predictors of outcome.

Keywords: 2D speckle-tracking echocardiography; afterload; basal systolic longitudinal strain; blood pressure; global systolic longitudinal strain.

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Figures

Figure 1
Figure 1
ROC curve for DPBLS and SPBLS as predictors of mortality. For DPBLS, the AUC was 0.651 with optimal threshold value of 15.1, sensitivity of 0.653, and specificity of 0.671. For SPBLS, the AUC was 0.610 with threshold value of 17.8, sensitivity of 0.579, and specificity of 0.643. DPBLS, diastolic blood pressure-adjusted basal longitudinal strain; SPBLS, systolic blood pressure-adjusted basal longitudinal strain.
Figure 2
Figure 2
Kaplan–Meier curves of overall survival. Patients stratified by ROC optimal thresholds for SPBLS (top) and DPBLS (bottom). DPBLS, diastolic blood pressure-adjusted basal longitudinal strain; SPBLS, systolic blood pressure-adjusted basal longitudinal strain.
Figure 3
Figure 3
ROC curve for SPBLS and DPBLS as predictors of cardiac events. For DPBLS, the AUC was 0.838 with optimal threshold value of 14.1, sensitivity of 0.711, and specificity of 0.895. For SPBLS, the AUC was 0.778 with optimal threshold value of 14.9, sensitivity of 0.818, and specificity of 0.632. DPBLS, diastolic blood pressure-adjusted basal longitudinal strain; SPBLS, systolic blood pressure-adjusted basal longitudinal strain.
Figure 4
Figure 4
Kaplan–Meier curves of for event-free follow-up. Patients stratified by ROC optimal thresholds for SPBLS (top) and DPBLS (bottom). DPBLS, diastolic blood pressure-adjusted basal longitudinal strain; SPBLS, systolic blood pressure-adjusted basal longitudinal strain.
Figure 5
Figure 5
Regression curves depicting the correlation between global longitudinal strain and (A) systolic blood pressure; (B) diastolic blood pressure.
Figure 6
Figure 6
Regression curves depicting the correlation between basal longitudinal strain and (A) systolic blood pressure; (B) diastolic blood pressure.
See this image and copyright information in PMC

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