In-Chang Hwang1, Goo-Yeong Cho2, Yeonyee E Yoon3, Jin Joo Park3. 1. Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. 2. Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea. Electronic address: cardioch@snu.ac.kr. 3. Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Abstract
BACKGROUND: The prognostic value of left ventricular (LV) global strain and twist in patients with left bundle branch block (LBBB) is not fully investigated. The aim of this study was to investigate the association between myocardial strain and twist and cardiovascular events in patients with LBBB, as assessed using two-dimensional speckle-tracking echocardiography. METHODS: A total of 269 patients with LBBB (mean age, 69.5 ± 10.9 years; 46.8% men) were retrospectively identified. Using speckle-tracking, LV global longitudinal strain (GLS), global circumferential strain, and twist were measured. Association between LV global function and a composite of cardiovascular mortality and hospitalization for heart failure was compared with clinical risk factors, LV ejection fraction (LVEF), and other echocardiographic parameters. RESULTS: During a median of 27.5 months (interquartile range, 12.8-43.9 months), the composite end point occurred in 55 patients (20.4%). In univariate analyses, diabetes mellitus, chronic kidney disease, ischemic etiology of LBBB, dilated left atrium, reduced LVEF, dilated left ventricle, and impaired LV global strain (GLS > -12.2%, global circumferential strain > -11.8%, and twist < 6.5°) showed associations with the composite end point. In multivariate analyses, GLS was significantly associated with the composite end point (adjusted hazard ratio, 4.697; 95% CI, 1.344-16.413; P = .015), whereas global circumferential strain, twist, and LVEF were not. GLS showed an additive association with poor prognosis over clinical risk factors and other echocardiographic parameters, including LVEF. Patients with preserved LVEFs (≥40%) but impaired GLS (>-12.2%) had a larger number of clinical events than those with impaired LVEFs but preserved GLS. CONCLUSIONS: Among patients with LBBB, GLS can provide better risk stratification than LVEF or other echocardiographic parameters.
BACKGROUND: The prognostic value of left ventricular (LV) global strain and twist in patients with left bundle branch block (LBBB) is not fully investigated. The aim of this study was to investigate the association between myocardial strain and twist and cardiovascular events in patients with LBBB, as assessed using two-dimensional speckle-tracking echocardiography. METHODS: A total of 269 patients with LBBB (mean age, 69.5 ± 10.9 years; 46.8% men) were retrospectively identified. Using speckle-tracking, LV global longitudinal strain (GLS), global circumferential strain, and twist were measured. Association between LV global function and a composite of cardiovascular mortality and hospitalization for heart failure was compared with clinical risk factors, LV ejection fraction (LVEF), and other echocardiographic parameters. RESULTS: During a median of 27.5 months (interquartile range, 12.8-43.9 months), the composite end point occurred in 55 patients (20.4%). In univariate analyses, diabetes mellitus, chronic kidney disease, ischemic etiology of LBBB, dilated left atrium, reduced LVEF, dilated left ventricle, and impaired LV global strain (GLS > -12.2%, global circumferential strain > -11.8%, and twist < 6.5°) showed associations with the composite end point. In multivariate analyses, GLS was significantly associated with the composite end point (adjusted hazard ratio, 4.697; 95% CI, 1.344-16.413; P = .015), whereas global circumferential strain, twist, and LVEF were not. GLS showed an additive association with poor prognosis over clinical risk factors and other echocardiographic parameters, including LVEF. Patients with preserved LVEFs (≥40%) but impaired GLS (>-12.2%) had a larger number of clinical events than those with impaired LVEFs but preserved GLS. CONCLUSIONS: Among patients with LBBB, GLS can provide better risk stratification than LVEF or other echocardiographic parameters.
Authors: Yan Chen; Yanjuan Zhang; Di Xu; Chun Chen; Changqing Miao; Huan Tang; Beibei Ge; Yan Shen; Jing Yao Journal: Int J Cardiovasc Imaging Date: 2022-02-09 Impact factor: 2.357
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Authors: Giuseppe Palmiero; Marta Rubino; Emanuele Monda; Martina Caiazza; Lucia D'Urso; Guido Carlomagno; Federica Verrillo; Raffaele Ascione; Fiore Manganelli; Giuseppe Cerciello; Maria Luisa De Rimini; Eduardo Bossone; Giuseppe Pacileo; Paolo Calabrò; Paolo Golino; Luigi Ascione; Pio Caso; Giuseppe Limongelli Journal: J Cardiovasc Echogr Date: 2021-10-26