Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure

Cho, Goo-Yeong, Marwick, Thomas H., Kim, Hyun-Sook, Kim, Min-Kyu, Hong, Kyung-Soon and Oh, Dong-Jin (2009) Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure. Journal of the American College of Cardiology, 54 7: 618-624. doi:10.1016/j.jacc.2009.04.061

Author Cho, Goo-Yeong
Marwick, Thomas H.
Kim, Hyun-Sook
Kim, Min-Kyu
Hong, Kyung-Soon
Oh, Dong-Jin
Title Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
Publication date 2009-08-11
Sub-type Article (original research)
DOI 10.1016/j.jacc.2009.04.061
Open Access Status
Volume 54
Issue 7
Start page 618
End page 624
Total pages 7
Place of publication San Diego, CA, United States
Publisher Elsevier
Subject 2705 Cardiology and Cardiovascular Medicine
Formatted abstract
Objectives: We sought to evaluate whether global 2-dimensional (2D) strain offers additional benefit over left ventricular ejection fraction (LVEF) to predict clinical events in heart failure.

Background: Although 2D strain based on speckle tracking has been proposed as a simple and reproducible tool to detect systolic dysfunction, the relationship of 2D strain and prognosis has not been studied.

Methods: Two hundred one patients (age 63 ± 11 years, 34% female, LVEF 34 ± 13%) hospitalized for acute heart failure underwent clinical evaluation and conventional and tissue Doppler echocardiography. Using dedicated software, we measured the global longitudinal strain (GLS) in apical 4- and 2-chamber views and the global circumferential strain (GCS) in a parasternal short-axis view. Cardiac events were defined as readmission for heart failure or cardiac death.

Results: There were 23.4% clinical events during 39 ± 17 months of follow-up. In univariate analysis, age, left atrial volume, left ventricular volume, LVEF, ratio of early transmitral flow to early diastolic annular velocity (E/e′), and both GLS and GCS were predictive of cardiac events. In multivariate Cox models, age (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.10, p = 0.017) and GCS (HR: 1.15, 95% CI: 1.04 to 1.28; p = 0.006) were independently associated with cardiac events. By Cox proportional hazards model, the addition of GCS markedly improved the prognostic utility of a model containing ejection fraction, E/e′, and GLS.

Conclusions: GCS is a powerful predictor of cardiac events and appears to be a better parameter than ejection fraction in patients with acute heart failure. 
Keyword Congestive heart failure
Ventricular function
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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