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

Author:

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

Abstract

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.

Funder

National Medical Research Council

Publisher

Frontiers Media SA

Subject

Cardiology and Cardiovascular Medicine

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