Left ventricular global longitudinal strain predicts elevated cardiac pressures and poor clinical outcomes in patients with non-ischemic dilated cardiomyopathy

Abstract

Background Risk stratification in patients with non-ischemic dilated cardiomyopathy (NI-DCM) is essential to treatment planning. Global longitudinal strain (GLS) predicts poor prognosis in various cardiac diseases, but it has not been evaluated in a cohort of exclusively NI-DCM. Although deformation parameters have been shown to reflect diastolic function, their association with other hemodynamic parameters needs further elucidation. We aimed to evaluate the association between GLS and E/GLS and invasive hemodynamic parameters and assess the prognostic value of GLS and E/GLS in a prospective well-defined pure NI-DCM cohort. Methods and results Forty-one patients with NI-DCM were enrolled in the study. They underwent a standard diagnostic workup, including transthoracic echocardiography and right heart catheterization. During a five-year follow-up, 20 (49%) patients reached the composite outcome measure: LV assist device implantation, heart transplantation, or cardiovascular death. Pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure, pulmonary vascular resistance (PVR) correlated with GLS and E/GLS (p < 0.05). ROC analysis revealed that GLS and E/GLS could identify elevated PCWP (≥ 15 mmHg) and PVR (> 3 Wood units). Survival analysis showed GLS and E/GLS to be associated with short- and long-term adverse cardiac events (p < 0.05). GLS values above thresholds of –5.34% and -5.96% indicated 18- and 12-fold higher risk of poor clinical outcomes at one and five years, respectively. Multivariate Cox regression analysis revealed that GLS is an independent long-term outcome predictor. Conclusion GLS and E/GLS correlate with invasive hemodynamics parameters and identify patients with elevated PCWP and high PVR. GLS and E/GLS predict short- and long-term adverse cardiac events in patients with NI-DCM. Worsening GLS is associated with incremental risk of long-term adverse cardiac events and might be used to identify high-risk patients.

Prognostic value of left ventricular global longitudinal strain and mechanical dispersion by speckle tracking echocardiography in patients with ischemic and nonischemic cardiomyopathy: a systematic review and meta-analysis

“…Основными конечными точками в исследованиях, где проводилась оценка ГПД и/или МД ЛЖ, являлись "аритмическая" конечная точка (5 исследований) [14,18,19,21,25], большие сердечно-сосудистые неблагоприятные события (MACE -Major adverse cardiovascular events) (5 исследований) [15,16,20,22,24] и обратное ремоделирование ЛЖ (1 исследование) [23].…”

“…Совокупность указанных событий мы рассчитывали, как большие MACE, с целью проведения дальнейшего метаанализа. В большинстве исследований, включенных в наш анализ, были представлены данные ГПД ЛЖ [14][15][16][17][19][20][21][22][23][24][25], в трех исследованиях [14,16,21], кроме того, представлены показатели МД ЛЖ, и в одном исследовании [18] проводилась только оценка значений МД ЛЖ. В таблице 3 представлены основные значения показателей ГПД и МД ЛЖ, а также данные о конечных точках и количестве событий в каждой группе.…”

Echocardiographic Advances in Dilated Cardiomyopathy

“…Additionally, GLS is a more powerful predictor of prognosis and outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and DCM [ 19 , 20 ] (both ischemic and non-ischemic) and represents a novel parameter for a better selection of patients for implantable cardiac defibrillator (ICD) implantation as a more accurate predictor of ventricular arrhythmias [ 21 ]. LV GLS correlates well with invasive hemodynamic parameters [ 22 , 23 ] and independently predict LV reversed remodeling (discussed further below) in patients with DCM: patients with higher baseline GLS presented better LV functional recovery leading to less adverse clinical events [ 24 ].…”

Inflammation-Related Biomarkers Are Associated with Heart Failure Severity and Poor Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy

“…All patients underwent standard transthoracic echocardiography to obtain conventional echocardiographic measurements within 24 h before interventional procedures. The methodology has been described in detail elsewhere [14], except severe LV diastolic dysfunction, which matched grade III according to recommendations [15]. Coronary angiography was performed to exclude coronary artery disease.…”

“…Coronary angiography was performed to exclude coronary artery disease. Right heart catheterization was performed as described previously [14]. In brief, the procedure was carried out for cardiac pressures (pulmonary capillary wedge pressure (PCWP), mean pulmonary arterial pressure (mPAP)) and cardiac index assessment, followed by endomyocardial biopsy from the interventricular septum.…”