Frontiers in Cardiovascular Medicine (Nov 2021)

Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis

  • Thu-Thao Le,
  • Thu-Thao Le,
  • Weiting Huang,
  • Weiting Huang,
  • Gurpreet K. Singh,
  • Desiree-Faye Toh,
  • See Hooi Ewe,
  • See Hooi Ewe,
  • Hak Chaw Tang,
  • Hak Chaw Tang,
  • Germaine Loo,
  • Jennifer A. Bryant,
  • Briana Ang,
  • Edgar Lik-Wui Tay,
  • Edgar Lik-Wui Tay,
  • Wern Miin Soo,
  • James Wei-Luen Yip,
  • Yen Yee Oon,
  • Lingli Gong,
  • Josephien B. Lunaria,
  • Quek Wei Yong,
  • Evelyn Min Lee,
  • Poh Shuan Daniel Yeo,
  • Poh Shuan Daniel Yeo,
  • Siang Chew Chai,
  • Ping Ping Goh,
  • Lee Fong Ling,
  • Hean Yee Ong,
  • Arthur Mark Richards,
  • Arthur Mark Richards,
  • Arthur Mark Richards,
  • Arthur Mark Richards,
  • Victoria Delgado,
  • Jeroen J. Bax,
  • Zee Pin Ding,
  • Zee Pin Ding,
  • Lieng-Hsi Ling,
  • Lieng-Hsi Ling,
  • Lieng-Hsi Ling,
  • Calvin W. L. Chin,
  • Calvin W. L. Chin,
  • Calvin W. L. Chin

DOI
https://doi.org/10.3389/fcvm.2021.750016
Journal volume & issue
Vol. 8

Abstract

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Aims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on cardiovascular magnetic resonance (CMR) and validate the prognostic value of LV-GLS thresholds associated with fibrosis.Methods and results: LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57 ± 10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71 ± 12 years; 58% males; NYHA functional class I–II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, and myocardial infarction. In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74 [0.66–0.83]; P < 0.001) and calibration (Hosmer-Lemeshow χ2 = 6.37; P = 0.605) for replacement fibrosis. In the outcome cohort, 47 events occurred over 16 [3.3, 42.2] months. Patients with LV-GLS > −15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS < −21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P < 0.001). LV-GLS offered independent prognostic value over clinical variables, AS severity and echocardiographic LV mass and E/e′.Conclusion: LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF.

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