Global Longitudinal Strain as an Efficient Prognostic Tool in Hypertrophic Cardiomyopathy With Preserved Left Ventricular Ejection Fraction

Abstract

Intending to demonstrate the utility of the global longitudinal strain (GLS) in patients with hypertrophic cardiomyopathy (HCM) and preserved ejection fraction, we describe a case of a 54-year-old female who presented to our emergency department with an acute onset of palpitations and chest pain. The patient was noted to have a new onset of atrial fibrillation. An echocardiogram showed an unimpaired ejection fraction suggesting normal left ventricular systolic function with findings of concentric left ventricular and apical hypertrophy. However, the speckled ultrasound revealed a GLS of -6.2%, suggesting marked impairment of ventricular wall movement. A CHA₂DS₂-VASc score was calculated and yielded a score of 2, indicating a moderate risk for thromboembolism. After a full evaluation of the case, the patient was started on anticoagulation due to her GLS result that suggested stasis within the left ventricle that may lead to a thrombus. Additional advice was to follow up closely for possible automatic implantable cardioverter defibrillator placement. We conclude that GLS is a cheap and easy tool to utilize as an additional prognostic marker for cardiovascular complications, particularly among those who have progression of HCM or start with symptoms such as atrial fibrillation and may have impaired left ventricular systolic function despite a preserved ejection fraction. Thus, we encourage the medical community to utilize and further study this novel technology.

Segmental and global longitudinal strain measurement by 2-dimensional speckle tracking echocardiography in severe rheumatic mitral stenosis

“…Speckle tracking echocardiography (STE) is a method of assessing cardiac function in which an echocardiographic device with the capability of identifying and tracking a certain point in the myocardium with specific echocardiographic characteristics within a block of speckles is used to determine the displacement of this speckle through the cardiac cycle. STE can calculate parameters like longitudinal, radial, or circumferential myocardial strain, global longitudinal strain (GLS), and strain rate [ 6 – 9 ]. However, longitudinal strain is generally believed to be a better predictor for various outcomes than other myocardial strain indices [ 10 , 11 ].…”