Left Ventricular 3‐Dimensional Global Longitudinal Strain Predicts All‐Cause Mortality in Patients With Heart Transplant

Abstract

Background The prognostic value of 3‐dimensional (3D)‐left ventricular global longitudinal strain (LVGLS) in recipients of heart transplant (HT) reremains unknown. This study aimed to determine whether 3D‐LVGLS was the more powerful predictor of poor outcomes in recipients of HT compared with 2‐dimensional (2D)‐LVGLS. Methods and Results All consecutive adult patients who received HT and underwent at least 1 comprehensive 2D and 3D transthoracic echocardiographic examination for clinical surveillance were retrospectively enrolled. The end point was all‐cause mortality. Prognostic model performance was assessed according to the C‐statistic. The 3D‐LVGLS measurements were feasible in 294 of 342 patients with HT (86%). The median follow‐up time was 53 months, and 44 HT redied. Receiver operating characteristic curves revealed that the area under the curve for predicting all‐cause mortality was greater for 3D‐LVGLS than 2D‐LVGLS (0.77 versus 0.67, P=0.012). When HT stratified patients with HT into tertiles according to 3D‐LVGLS values, patients with lower 3D‐LVGLS had worse outcome (P<0.001). The multivariable Cox analysis showed that the model with 3D‐LVGLS (hazard ratio [HR],1.44 [95% CI,1.24–1.68]; P<0.001; C‐statistic=0.814) was better in predicting death than the model with 2D‐LVGLS (HR, 1.19 [95% CI, 1.06–1.32]; P=0.002; C‐statistic=0.772). The best cutoff value of 3D‐LVGLS for detecting all‐cause mortality was −16.1%, with a sensitivity of 63.6% and a specificity of 84.0%. Conclusions The 3D‐LVGLS was a powerful predictor of all‐cause mortality in patients receiving HT and provided greater prognostic value than 2D‐LVGLS. Our study highlighted the potential of evaluating 3D‐LVGLS for risk stratification in recipients of HT.

Keywords

• all‐cause mortality
• heart transplant
• left ventricular global longitudinal strain
• speckle tracking echocardiography