Normal Global Longitudinal Strain

D’Elia, Nicholas; Caselli, Stefano; Kosmala, Wojciech; Lancellotti, Patrizio; Morris, Daniel A.; Muraru, Denisa; Takeuchi, Masaaki; Bosch, Annemien van den; Grootel, Roderick W. J. van; Villarraga, Hector R.; Marwick, Thomas H.

doi:10.1016/j.jcmg.2019.07.020

Cited by 62 publications

(27 citation statements)

References 9 publications

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“…The automated algorithm traces and tracks the LV myocardium, with manual adjustments made when appropriate, and the software calculates GLS from the weighted average of the peak systolic longitudinal strain of all segments using the 17 segment model. GLS is quantified as a negative number with cutoff as −18%, and more negative as normal for this system, but based on prior literature supporting use of a cutoff of −16% as the threshold for normal, analyses were conducted with > −16% as the cutoff for normal (21)(22)(23)(24)(25). Tracking quality was assessed by the operator and over-ridden in segments with two or fewer rejected regions where the operator deemed tracking quality to be acceptable.…”

Section: Speckle Tracking Echocardiography Analysismentioning

confidence: 99%

Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

Minhas

Gilotra

Goerlich

et al. 2021

Front. Cardiovasc. Med.

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Background: Although troponin elevation is common in COVID-19, the extent of myocardial dysfunction and its contributors to dysfunction are less well-characterized. We aimed to determine the prevalence of subclinical myocardial dysfunction and its association with mortality using speckle tracking echocardiography (STE), specifically global longitudinal strain (GLS) and myocardial work efficiency (MWE). We also tested the hypothesis that reduced myocardial function was associated with increased systemic inflammation in COVID-19.Methods and Results: We conducted a retrospective study of hospitalized COVID-19 patients undergoing echocardiography (n = 136), of whom 83 and 75 had GLS (abnormal >−16%) and MWE (abnormal <95%) assessed, respectively. We performed adjusted logistic regression to examine associations of GLS and MWE with in-hospital mortality. Patients were mean 62 ± 14 years old (58% men). While 81% had normal left ventricular ejection fraction (LVEF), prevalence of myocardial dysfunction was high by STE; [39/83 (47%) had abnormal GLS; 59/75 (79%) had abnormal MWE]. Higher MWE was associated with lower in-hospital mortality in unadjusted [OR 0.92 (95% CI 0.85–0.99); p = 0.048] and adjusted models [aOR 0.87 (95% CI 0.78–0.97); p = 0.009]. In addition, increased systemic inflammation measured by interleukin-6 level was associated with reduced MWE.Conclusions: Subclinical myocardial dysfunction is common in COVID-19 patients with clinical echocardiograms, even in those with normal LVEF. Reduced MWE is associated with higher interleukin-6 levels and increased in-hospital mortality. Non-invasive STE represents a readily available method to rapidly evaluate myocardial dysfunction in COVID-19 patients and can play an important role in risk stratification.

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Section: Speckle Tracking Echocardiography Analysismentioning

confidence: 99%

Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

Minhas

Gilotra

Goerlich

et al. 2021

Front. Cardiovasc. Med.

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“…Possible explanations for this is that global LS is commonly reduced in patients with established cardiovascular risk factors such as hypertension and diabetes 29 – 31 but as these are present in >90% of non-HFpEF patients, this likely reduced the diagnostic accuracy of global LS. In addition, global LS has been shown to be lower in older patients 32 and our HFpEF and non-HFpEF cohort are predominantly of an older age; thus, this may have further reduced the diagnostic power of global LS. In addition, the ESC 2021 guidelines does not recommend echocardiography global LS as it has a sensitivity of 62% and 56% compared to invasive testing.…”

Section: Discussionmentioning

confidence: 85%

Diagnostic accuracy of cardiovascular magnetic resonance strain analysis and atrial size to identify heart failure with preserved ejection fraction

Kwan

Yap

et al. 2023

European Heart Journal Open

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Aims Heart failure with preserved ejection fraction (HFpEF) continues to be a diagnostic challenge. CMR atrial measurements, feature-tracking (CMR-FT), tagging have long been suggested to diagnose HFpEF and potentially complement echocardiography especially when echocardiography is indeterminate. Data supporting the use of atrial measurements, CMR-FT or tagging is absent. Our aim is to conduct a prospective case-control study assessing the diagnostic accuracy of CMR atrial volume/area, CMR-FT, and tagging to diagnose HFpEF amongst patients suspected of having HFpEF. Methods & Results 121 suspected HFpEF patients were prospectively recruited from four centres. Patients underwent echocardiography, CMR, NT-proBNP measurements within 24 hours to diagnose HFpEF. Patients without HFpEF diagnosis underwent catheter pressure measurements or stress echocardiography to confirm HFpEF or non-HFpEF. Area under the curve (AUC) were determined by comparing HFpEF with non-HFpEF patients. 53 HFpEF (median age 78yrs, interquartile range 74-82yrs) and 38 non-HFpEF (median age 70yrs, interquartile range 64-76yrs). CMR left atrial (LA) reservoir strain (ResS), LA area indexed (LAAi) and LA volume indexed (LAVi) had the highest diagnostic accuracy (AUCs 0.803, 0.815 and 0.776 respectively). LA ResS, LAAi and LAVi had significantly better diagnostic accuracy than CMR-FT left ventricle (LV)/right ventricle (RV) parameters and tagging (p < 0.01). Tagging circumferential and radial strain had poor diagnostic accuracy (AUC 0.644 and 0.541 respectively). Conclusion CMR LA ResS, LAAi and LAVi have the highest diagnostic accuracy to identify HFpEF patients from non-HFpEF patients amongst clinically suspected HFpEF patients. CMR-FT LV/RV parameters and tagging had low diagnostic accuracy to diagnose HFpEF.

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“…Guidelines define a GLS ≤ –20% as a normal value in healthy subjects [ 26 ]. A recent meta-analysis reports that a GLS > -16% indicates significant myocardial dysfunction [ 44 ]. There are no defined GLS cut-off values for risk estimation in different cardiac pathologies, although these would be useful for prognostication, management, and future studies.…”

Section: Discussionmentioning

confidence: 99%

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

Kažukauskienė

Balčiūnaitė

Baltrūnienė

et al. 2021

Cardiovasc Ultrasound

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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.

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Normal Global Longitudinal Strain

Cited by 62 publications

References 9 publications

Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality

Diagnostic accuracy of cardiovascular magnetic resonance strain analysis and atrial size to identify heart failure with preserved ejection fraction

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

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