Post-systolic shortening is superior to global longitudinal strain in predicting adverse events in patients with stable coronary artery disease and preserved systolic function

Abstract

Background Post-systolic shortening (PSS) is an important indicator for early identifying myocardial dysfunction. We aimed to investigate the predictive value of PSS assessed with speckle tracking automated functional imaging (AFI) on adverse events in patients with stable coronary artery disease (CAD) and preserved systolic function. Methods A total of 204 consecutive patients clinically diagnosed with stable CAD and left ventricular ejection fraction (LVEF) > 50% were included. Multiple parameters were analyzed with AFI technique. The composite endpoint included all-cause mortality, heart failure, myocardial infarction and stroke. Results During a median follow-up of 24 months (IQR 19–28 months), 30 patients (14.7%) reached the endpoint. Patients experiencing the endpoint had a lower absolute global longitudinal strain (GLS), a higher post-systolic index (PSI), and more left ventricle walls displaying PSS than patients without events. PSI (hazard ratio, 1.15; 95% CI, 1.04–1.27; p = 0.005) and per 1 increase in the number of left ventricle walls with PSS (hazard ratio 1.52, 95% CI 1.21–1.91, p < 0.000) were independent predictors of the endpoint, whereas GLS was not significantly associated with the endpoint after adjustment models. For patients with absolute value of GLS > 15.4%, a significant prognostic superiority was found in PSI compared with GLS (AUC = 0.73 [PSI] vs. 0.58 [GLS], p = 0.024). Conclusions PSS is an independent predictor for adverse events in stable CAD patients with preserved systolic function, and the prognostic value may be superior to GLS in patients with normal or mildly reduced GLS.

Incremental prognostic utility of left ventricular and left atrial strains in coronary artery disease patients with reduced systolic function

“…Strain does not require geometric assumptions, is less load‐dependent, has a lower interobserver variability and a higher sensitivity for the detection of subtle myocardium dysfunction than LVEF 8,31 . We have reported the superior prognostic ability of GLS than LVEF in stable CAD patients with preserved systolic function 13 . In addition to preserved LVEF, growing evidence supports an incremental prognostic role of longitudinal strain in patients with reduced LVEF.…”

“…8,31 We have reported the superior prognostic ability of GLS than LVEF in stable CAD patients with preserved systolic function. 13 In addition to preserved LVEF, growing evidence supports an incremental prognostic role of longitudinal strain in patients with reduced LVEF. Dahou et al 32 reported that GLS is independently associated with mortality in patients with low LVEF and aortic stenosis.…”

“…We have reported the superior utility of GLS over LVEF in stable CAD with preserved LVEF in predicting adverse events. 12,13 As the chamber connecting LV and pulmonary veins, deterioration of left atrial (LA) structure and function contributes to poor prognosis in cardiovascular disease. 14 LA reservoir strain (LARS), a high-profile new parameter for evaluating LA subclinical function, has been proposed…”

“…GLS could differentiate the prognosis after coronary artery bypass grafting in patients with preserved LVEF and provide significant incremental prognostic value to LVEF. We have reported the superior utility of GLS over LVEF in stable CAD with preserved LVEF in predicting adverse events 12,13 …”

Association of postsystolic shortening on stress echocardiography and significant coronary artery stenosis: A single‐centre retrospective cohort study

“…Studies(Celutkiene et al, 2012;Pellikka et al, 2020) have suggested that newer technology is required to make the quantification of PSS userfriendly and less time-consuming. Consequently, future studies should focus on the feasibility of the quantification of PSS to enable its practice in clinical work.Furthermore, the prognostic value of PSS has recently been elucidated among the healthy population and patients with suspected or verified CADLu et al, 2022). Considering our results, one hypothesis would be that the risk is not solely attributed to obstructive CAD.…”