Journal of the Formosan Medical Association (Aug 2022)

Prognostic superiority of global longitudinal strain beyond four-tiered ventricular hypertrophy in asymptomatic individuals

  • Kuo-Tzu Sung,
  • Yi-Hsuan Chen,
  • Jen-Yuan Kuo,
  • Yau-Huei Lai,
  • Chi-In Lo,
  • Wen-Hung Huang,
  • Shih-Chieh Chien,
  • Lawrence Yu-Min Liu,
  • Bernard Bulwer,
  • Charles Jia-Yin Hou,
  • Cheng-Huang Su,
  • Ta-Chuan Hung,
  • Chung-Lieh Hung,
  • Hung-I Yeh

Journal volume & issue
Vol. 121, no. 8
pp. 1414 – 1424

Abstract

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Background: This study aims to explore the clinical correlates of myocardial deformations using speckle-tracking algorithm and to determine the prognostic utility of such measures in asymptomatic ethnic Chinese population. Methods: Global longitudinal (GLS), circumferential strain (GCS), and torsion were analyzed using featured tissue-tracking algorithm among 4049 symptom-free ethnic Chinese population. Hypertrophy (LVH) was classified into 4 tiers: indeterminate, dilated, thick and thick/dilated, by gender-stratified partition of end-diastolic volume index (EDVi) and LV mass/EDV0.67. Results: LVH (7.3%) showed substantially lower GLS (−20.3 ± 1.82% vs. −18.9 ± 2.08%) yet higher torsion (2.20 ± 0.90 vs. 2.39 ± 1.01, p < 0.001) than non-LVH participants. Those with thick LVH (n = 123) were more obese, had higher blood pressure and increased high-sensitivity C-reactive protein (hs-CRP); with dilated/thick LVH (n = 26) group demonstrating highest pro-brain natriuretic peptide (NT-proBNP) and worse GLS compared to indeterminate-/non-LVH groups. There were independent associations among larger EDVi, higher NT-proBNP and decreased torsion, and among greater LV mass/EDV0.67, worse GLS, greater GCS/torsion and hs-CRP. Over a median of 2.3 years (IQR: 1.2–4.8), the dilated, thick, and dilated/thick LVH categorizations were associated with higher risk of composite all-cause death and heart failure (HF) compared to non-LVH (adjusted hazard ratio [HR]: 3.65, 3.72, 6.01, respectively, all p < 0.05). Per 1% GLS reduction was independently associated with higher risk (adjusted HR: 1.31, p < 0.001) and improved risk prediction (p ≤ 0.001 by integrated discrimination improvement [IDI]: 3.5%, 95% CI: 1.5%–5.6%, and continuous net reclassification improvement [NRI]: 42.3%, 95% CI: 24.0%–60.6%) over LVH. Conclusion: GLS improved risk stratification of four-tiered classification of LVH in asymptomatic ethnic Chinese.

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