Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

Cheng, Susan; McCabe, Elizabeth L.; Larson, Martin G.; Merz, Allison A.; Osypiuk, Ewa; Lehman, Brad; Stantchev, Plamen; Aragam, Jayashri; Solomon, Scott D.; Benjamin, Emelia J.; Vasan, Ramachandran S.

doi:10.1161/jaha.115.002071

Cited by 63 publications

(93 citation statements)

References 47 publications

(88 reference statements)

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“…Thus, additional studies should be performed in other age groups and ethnicities to establish the generalizability of our results. We and others have previously reported on associations of arterial stiffness in relation to adverse cardiovascular events and on the relation of altered myocardial long‐axis strain with all‐cause mortality 4, 65, 66. For the present study sample, in whom both arterial stiffness and myocardial strain measures were performed, the limited number of total events adjudicated to date precludes adequately powered analyses of their combined effects on outcomes.…”

Section: Discussionmentioning

confidence: 92%

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Bell

McCabe

Larson

et al. 2017

JAHA

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BackgroundAortic stiffness impairs optimal ventricular–vascular coupling and left ventricular systolic function, particularly in the long axis. Left ventricular global longitudinal strain (GLS) has recently emerged as a sensitive measure of early cardiac dysfunction. In this study, we investigated the relation between aortic stiffness and GLS in a large community‐based sample.Methods and ResultsIn 2495 participants (age 39–90 years, 57% women) of the Framingham Offspring and Omni cohorts, free of cardiovascular disease, we performed tonometry to measure arterial hemodynamics and echocardiography to assess cardiac function. Aortic stiffness was evaluated as carotid–femoral pulse wave velocity and as characteristic impedance, and GLS was calculated using speckle tracking–based measurements. In multivariable analyses adjusting for age, sex, height, systolic blood pressure, augmentation index, left ventricular structure, and additional cardiovascular risk factors, increased carotid–femoral pulse wave velocity (B±SE: 0.122±0.030% strain per SD, P<0.0001) and characteristic impedance (0.090±0.029, P=0.002) were both associated with worse GLS. We observed effect modification by sex on the relation between characteristic impedance and GLS (P=0.004); in sex‐stratified multivariable analyses, the relation between greater characteristic impedance and worse GLS persisted in women (0.145±0.039, P=0.0003) but not in men (P=0.73).ConclusionsMultiple measures of increased aortic stiffness were cross‐sectionally associated with worse GLS after adjusting for hemodynamic variables. Parallel reductions in left ventricular long axis shortening and proximal aortic longitudinal strain in individuals with a stiffened proximal aorta, from direct mechanical ventricular‐vascular coupling, offers an alternative explanation for the observed relations.

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Section: Discussionmentioning

confidence: 92%

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Bell

McCabe

Larson

et al. 2017

JAHA

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“…In addition to conventional echocardiography together with measurements of LV volumes and EF, the 2D speckle tracking technique opens up the possibility of noninvasively evaluating myocardial deformation (strain). 12 Recent clinical studies explored the prognostic role of these new LV strain indexes. Three studies [5][6][7] in patients with symptomatic HF and reduced EF demonstrated that low LV GLS is superior to EF in identifying patients with poor outcomes, such as all-cause or cardiac mortality and recurrent hospitalization for HF.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 On the contrary, population-based studies are essential to determine the prognostic significance of subclinical LV systolic dysfunction. To date, 2 community-based studies reported on the incremental predictive value of magnetic resonance imaging 11 or echocardioraphically 12 derived LV circumferential strain for incident HF and coronary heart disease. To our knowledge,…”

Section: See Clinical Perspectivementioning

confidence: 99%

“…1,2,11 In 1768, asymptomatic participants (mean age, 65 years) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA), 11 LV circumferential strain assessed by magnetic resonance imaging provided incremental predictive value for incident HF. In this study, the author did not measure GLS.11 In the Framingham Heart Study (n=2831; mean age, 66 years), 12 LV GLS was borderline associated with incident coronary heart events (hazards ratio per SD increment 1.29; P=0.05), whereas circumferential strain was a significant predictor of incident HF (1.79; P<0.0001). Decrements in longitudinal and circumferential strain were significantly related to all-cause mortality in the Framingham study.…”

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confidence: 92%

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Additive Prognostic Value of Left Ventricular Systolic Dysfunction in a Population-Based Cohort

Kuznetsova

Cauwenberghs

Knez

et al. 2016

Circ: Cardiovascular Imaging

105

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Background-Techniques of 2-dimensional speckle tracking enable the measurement of myocardial deformation (strain) during systole. Recent clinical studies explored the prognostic role of left ventricular global longitudinal strain (GLS). However, there are few data on the association between cardiovascular outcome and GLS in the community. Therefore, we hypothesized that GLS contains additive prognostic information over and beyond traditional cardiovascular risk factors in a large, population-based cohort. Methods and Results-We measured GLS by 2-dimensional speckle tracking in the apical 4-chamber view in 791 participants (mean age 50.9 years). We calculated multivariable adjusted hazard ratios for midwall, endocardial, and epicardial GLS, while accounting for family cluster and cardiovascular risk factors. Median follow-up was 7.9 years (5th to 95th percentile, 3.7-9.6). In continuous analysis, with adjustments applied for covariables, midwall, endocardial, and epicardial GLS were significant predictors of fatal and nonfatal cardiovascular (n=96; P<0.0001) and cardiac events (n=68; P≤0.001). In the sex-specific low quartile of midwall GLS (<18.8% in women and <17.4% in men), the risk was significantly higher than the average population risk for cardiovascular (128%, P<0.0001) and cardiac (94%, P=0.0007) events. We also noticed that the risk for cardiovascular events increased with increasing number of left ventricular abnormalities, such as low GLS, diastolic dysfunction, and hypertrophy (log-rank P<0.0001). Conclusions-Low GLS measured by 2-dimensional speckle tracking predicts future cardiovascular events independent of conventional risk factors. Left ventricular midwall strain represents a simple echocardiographic measure, which might be used for assessing cardiovascular risk in a population-based cohort. Methods Study ParticipantsThe Ethics Committee of the University of Leuven approved the Flemish Study on Environment, Genes and Health Outcomes (FLEMENGHO), a large family-based population resource on the genetic epidemiology of cardiovascular phenotypes. 13,14 From August 1985 to December 2005, we identified a random population sample stratified by sex and age from a geographically defined area in northern Belgium as described in the Data Supplement.13,14 From 2005 to 2009, we invited 1031 former participants for a technical examination at our field center, including echocardiography. We obtained informed written consent from 828 subjects (participation rate, 80%). To study the incidence of mortality and morbidity in relation to baseline LV systolic dysfunction, we collected outcome data on average 7.9 years after their first echocardiographic examination. For the current analysis, we further excluded 37 subjects because of atrial fibrillation (n=8), the presence of an artificial pacemaker (n=3), or because of GLS (n=22) or diastolic function (n=4) could not be reliably determined. Thus, the outcome cohort included 791 participants. EchocardiographyEchocardiographic methods are detailed in Methods sectio...

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“…Several community-based studies [47,64,65] have demonstrated that low global LS is associated with a greater risk for future cardiovascular and cardiac events [47]. For instance, FLEMENGHO participants belonging to the lower quartile of global LS distribution (i.e.…”

Section: Longitudinal Strain and Afterloadmentioning

confidence: 99%

Sex-specific differences in cardiac maladaptation to hypertension and arterial stiffening

Cauwenberghs

Kuznetsova

2018

Kardiol Pol

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A b s t r a c tThe overall prevalence of symptomatic heart failure (HF) is similar in men and women and constitutes about a quarter of the first manifestation of cardiovascular disease in both sexes. However, there is an important difference between the sexes in the type of HF. Whereas men more frequently develop HF with reduced ejection fraction, HF with preserved ejection fraction is especially frequent in women. The major risk factors for symptomatic HF are high blood pressure and arterial stiffness, which evoke a complex network of functional and structural changes in the heart in both men and women. In this review, we will discuss the recent epidemiological data on sex discrepancies in cardiac maladaptation to hypertension and arterial stiffening.

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Distinct Aspects of Left Ventricular Mechanical Function Are Differentially Associated With Cardiovascular Outcomes and All‐Cause Mortality in the Community

Cited by 63 publications

References 47 publications

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Additive Prognostic Value of Left Ventricular Systolic Dysfunction in a Population-Based Cohort

Sex-specific differences in cardiac maladaptation to hypertension and arterial stiffening

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