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

Cardiovascular Ultrasound

Sigitas Čibiras¹  Vytė Valerija Maneikienė²  Giedrė Balčiūnaitė²  Kęstutis Ručinskas²  Jelena Čelutkienė²  Vaida Baltrūnienė³  Ieva Kažukauskienė³  Virginija Grabauskienė⁴ 

[1] Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Santariškių 2, 08661, Vilnius, Lithuania;Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101, Vilnius, Lithuania;Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101, Vilnius, Lithuania;Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101, Vilnius, Lithuania;Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21, 03101, Vilnius, Lithuania;

关键词: Non-ischemic dilated cardiomyopathy;    Global longitudinal strain;    Strain-based index;    Prognosis;    Invasive hemodynamics;    Heart failure;   

DOI  :  10.1186/s12947-021-00254-1

来源: Springer

【 摘 要 】

BackgroundRisk 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 resultsForty-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.ConclusionGLS 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.

【 授权许可】

CC BY