Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Hypertrophic Obstructive Cardiomyopathy Patients and Preserved Left Ventricular Ejection Fraction

Abstract

BackgroundIn obstructive hypertrophic cardiomyopathy patients with preserved left ventricular (LV) ejection fraction, we sought to determine whether LV global longitudinal strain (LV‐GLS) provided incremental prognostic utility.Methods and ResultsWe studied 1019 patients with documented hypertrophic cardiomyopathy (mean age, 50±12 years; 63% men) evaluated at our center between 2001 and 2011. We excluded age <18 years, maximal LV outflow tract gradient <30 mm Hg, bundle branch block or atrial fibrillation, past pacemaker/cardiac surgery, including myectomy/alcohol ablation, and obstructive coronary artery disease. Average resting LV‐GLS was measured offline on 2‐, 3‐, 4‐chamber views using Velocity Vector Imaging (Siemens, Malvern, PA). Outcome was a composite of cardiac death and appropriate internal defibrillator (implantable cardioverter defibrillator) discharge. Maximal LV thickness, LV ejection fraction, indexed left atrial dimension, rest and maximal LV outflow tract gradient, and LV‐GLS were 2.0±0.2 cm, 62±4%, 2.2±4 cm/m2, 52±42 mm Hg, 103±36 mm Hg, and −13.6±4%. During 9.4±3 years of follow‐up, 668 (66%), 166 (16%), and 122 (20%), respectively, had myectomy, atrial fibrillation, and implantable cardioverter defibrillator implantation, whereas 69 (7%) had composite events (62 cardiac deaths). Multivariable competing risk regression analysis revealed that higher age (subhazard ratio, 1.04 [1.02–1.07]), AF during follow‐up (subhazard ratio, 1.39 [1.11–1.69]), and worsening LV‐GLS (subhazard ratio, 1.11 [1.05–1.22]) were associated with worse outcomes, whereas myectomy (subhazard ratio, 0.44 [0.25–0.72]) was associated with improved outcomes (all P<0.01). Sixty‐one percent of events occurred in patients with LV‐GLS worse than median (−13.7%).ConclusionsIn obstructive hypertrophic cardiomyopathy patients with preserved LV ejection fraction, abnormal LV‐GLS was independently associated with higher events, whereas myectomy was associated with improved outcomes.

Impaired left ventricular mechanics and functional reserve are associated with reduced exercise capacity in patients with hypertrophic cardiomyopathy

“…However, 2D‐STI has been used to evaluate myocardial mechanics in HCM patients at rest rather than during exercise, which skews the ability to identify deformational mechanics in HCM patients. Although recent studies have demonstrated that LV global longitudinal strain (LVGLS) and systolic strain rate (SR) reserve are associated with poor prognosis despite normal LV ejection fraction, these studies overlooked the effects of LV diastolic function and its reserve on exercise capacity . Therefore, overall changes in LV mechanics and functional reserve, as well as their association with functional capacity in HCM patients, measured using exercise stress echocardiography and 2D‐STI have not been thoroughly evaluated.…”

Cardiac impact of arteriovenous fistulas: what tools to assess?

“…GLS by speckle tracking is a sensitive parameter and its alteration occurs early in myocardial alteration process in comparison to increase of left ventricular volumes or LVEF [25]. Using a cut-off value of − 18% to define alteration of the GLS [26], which is associated with poor cardiac outcomes [27][28][29][30][31][32], we showed that Qa (using a threshold of 2250 mL/min) and Qa/CO (using a threshold of 33%) are the best tools to detect the early impact of vascular access flow on myocardium.…”

Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review

“…However, the LV mass reduction does not necessarily lead to complete LV diastolic function improvement because LV mass decrease is slow and continues in a nonlinear fashion. The fibrotic component of the LV mass may take several years to regress after the TAVR and can even become permanent [ 14 , 19 , 20 ].…”

“…Controversial studies were reported about the impact of different degrees of PVR on outcomes after TAVR [ 31 , 40 ]. Sato et al found increased LVEDP among patients who died within 1 year after TAVR, and presence of post-TAVR aortic regurgitation was the only independent predictor of mortality at 1 year [ 20 ]. Halkin et al did not find any significant association between mild PVR and post-TAVR mortality, but moderate to severe PVR was shown to be an independent predictor of all-cause mortality at mid-term follow-up (30 months) [ 22 ].…”