Myocardial Strain to Predict Mid-term Mortality and Re-hospitalization in Patients With Heart Failure and Reduced Ejection Fraction

Abstract

Background: Heart failure (HF) is a severe clinical syndrome caused by diversed etiologies. Classically left ventricle ejection fraction (LVEF) has been used as a diagnostic marker as well as to subdivide HF into 3 groups (HFpEF, HFmEF and HFrEF). However, the prognostic value of this index is not consistent in comparison to LV strain (GLS, GCS) which are not only able to detect heart failure at a very early stage (precede to EF change) but also to predict the primary outcome including HF readmission and death. The prognostic role of LV strain is independent and incremental to conventional echocardiographic parameters.
 Methods: 67 patients diagnosed with chronic HFrEF (EF < 40%) in Vietnam National Heart Institute were consecutively enrolled in our study from January 2016 to September 2016. Clinical data were comprehensively evaluated and conventional echocardiographic parameters and two LV strain indices (GLS & GCS) were measured using speckle-tracking. All patients were followed-up for all-cause 12-month readmission or death after discharge. The relation between echocardiographic parameters and clinical events was analyzed in Cox proportional hazard model.
 Results: GLS had a prognostic value of composite events after being adjusted with age, sex, heart rate, SBP, DBP, NT-ProBNP, renal clearance, LVEF and LVDd. GLS (cut-off = -7.5%; AUC = 0.738; p = 0.003) was a stronger predictor of composite event compared to LVEF (AUC= 0.66, p = 0.042) LVDd (AUC = 0.637; p = 0.025), LA diameter (AUC = 0.614, p = 0.03), NT-ProBNP (AUC = 0.663; p = 0.04) and hs-Troponin T (AUC = 0.592; p = 0.039).
 Conclusion: Global longitudinal strain is and strong and independent predictor of readmission and death in patients with heart failure with reduced ejection fraction.