Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality


Ozer P. , Govdeli E. A. , Engin B., Atici A., Baykiz D. , Orta H. , ...More

Anatolian Journal of Cardiology, vol.25, no.12, pp.863-871, 2021 (Journal Indexed in SCI Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 25 Issue: 12
  • Publication Date: 2021
  • Doi Number: 10.5152/anatoljcardiol.2021.21940
  • Journal Name: Anatolian Journal of Cardiology
  • Journal Indexes: Science Citation Index Expanded, Scopus, Academic Search Premier, CINAHL, EMBASE, MEDLINE, Directory of Open Access Journals, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.863-871
  • Keywords: left ventricular hypertrophy, hypertension, hypertrophic cardiomyopathy, athlete's heart, speckle-tracking echocardiography, PHYSIOLOGICAL CARDIAC-HYPERTROPHY, 2-DIMENSIONAL STRAIN, DIASTOLIC FUNCTION, FILLING PRESSURES, ECHOCARDIOGRAPHY, CARDIOMYOPATHY, HEART, RECOMMENDATIONS, DEFORMATION, SOCIETY

Abstract

© 2021 by Turkish Society of CardiologyObjective: In this study, we aimed to compare the functional adaptations of the left ventricle in variant forms of left ventricular hypertrophy (LVH) and to evaluate the use of two-dimensional speckle tracking echocardiography (2D-STE) in differential diagnosis and prognosis. Methods: This was a prospective cohort study of 68 patients with LVH, including 20 patients with non-obstructive hypertrophic cardiomyopathy (HCM), 23 competitive top-level athletes free of cardiovascular disease, and 25 patients with hypertensive heart disease (HHD). All the subjects underwent 2D transthoracic echocardiography (TTE) and 2D-STE. The primary endpoint was all-cause mortality. Global longitudinal strain (GLS) below −12.5% was defined as severely reduced strain, −12.5% to −17.9% as mildly reduced strain, and above −18% as normal strain. Results: The mean LV-GLS value was higher in athletes than in patients with HCM and HHD with the lowest value being in the HCM group (HCM: −11.4±2.2%; HHD: −13.6±2.6%; and athletes: −15.5±2.1%; p<0.001 among groups). LV-GLS below −12.5% distinguished HCM from others with 65% sensitivity and 77% specificity [area under curve (AUC)=0.808, 95% confidence interval (CI): 0.699-0.917, p<0.001]. The median follow-up duration was 6.4±1.1 years. Overall, 11 patients (16%) died. Seven of these were in the HHD group, and four were in the HCM group. The mean GLS value in patients who died was −11.8±1.5%. LV-GLS was significantly associated with mortality after adjusting age and sex via multiple analysis (RR=0.723, 95% CI: 0.537-0.974, p=0.033). Patients with GLS below −12.5% had a higher risk of all-cause mortality compared with that of patients with GLS above −12.5% according to Kaplan-Meier survival analysis for 7 years (29% vs. 9%; p=0.032). The LV-GLS value predicts mortality with 64% sensitivity and 70% specificity with a cut-off value of −12.5 (AUC=0.740, 95% CI: 0.617-0.863, p=0.012). Conclusion: The 2D-STE provides important information about the longitudinal systolic function of the myocardium. It may enable differentiation variable forms of LVH and predict prognosis.