Longitudinal Strain In Patients Research Articles

Prognostic value of global longitudinal strain in patients with preserved left ventricular systolic function: A cardiac magnetic resonance real-world study

BackgroundMyocardial strain is a more sensitive parameter for cardiac function evaluation than left ventricular ejection fraction (LVEF). This study aimed to assess the predictive value of left ventricular global longitudinal strain (LV-GLS) by feature tracking-cardiac magnetic resonance (FT-CMR) imaging in patients with known or suspected coronary artery disease (CAD) with preserved left ventricular systolic function. MethodsThis retrospective cohort analysis enrolled patients with known or suspected CAD who underwent CMR imaging during September 2017 to December 2019. LV-GLS was analyzed via feature-tracking analysis. Patients with LVEF <50% were excluded. The composite outcome comprised all-cause death, non-fatal myocardial infarction, heart failure. ResultsThere was a total of 2,613 patients. mean follow-up duration was 39.7±13.9 months. During follow-up, 194 patients (7.4%) experienced a composite outcome. The best cut off of LV-GLS in the prediction of composite outcome from Receiver-Operating-Characteristics was -14.4%. Patients were classified into 2 groups according to the LV-GLS; 1,489 (57.0%) had LV GLS <-14.4% and 1,124 (43.0%) had LV-GLS ≥-14.4%. Patients with LV-GLS ≥ -14.4% had a significantly higher rate of composite outcome than LV-GLS < -14.4% patients (3.59 vs. 1.39 per 100 person-years, respectively; p<0.001). Multivariable analysis showed that patients with LV-GLS ≥ -14.4% had a significantly higher risk of experiencing a composite outcome event compared to GLS < -14.4% patients (adjusted hazard ratio: 1.83, 95% confidence interval: 1.28-2.61; p=0.001). ConclusionLV-GLS by FT-CMR was shown to be useful for predicting the prognosis of patients with known or suspected CAD with preserved left ventricular systolic function. LV-GLS -14.4% was the identified cut-off for prognostic determination.

Correlation between the triglyceride-glucose index and left ventricular global longitudinal strain in patients with chronic heart failure: a cross-sectional study

BackgroundLeft ventricular global longitudinal strain (GLS) holds greater diagnostic and prognostic value than left ventricular ejection fraction (LVEF) in the heart failure (HF) patients. The triglyceride-glucose (TyG) index serves as a reliable surrogate for insulin resistance (IR) and is strongly associated with several adverse cardiovascular events. However, there remains a research gap concerning the correlation between the TyG index and GLS among patients with chronic heart failure (CHF).Method427 CHF patients were included in the final analysis. Patient demographic information, along with laboratory tests such as blood glucose, lipids profiles, and echocardiographic data were collected. The TyG index was calculated as Ln [fasting triglyceride (TG) (mg/dL) × fasting plasma glucose (FPG) (mg/dL)/2].ResultsAmong CHF patients, GLS was notably lower in the higher TyG index group compared to the lower TyG index group. Following adjustment for confounding factors, GLS demonstrated gradual decrease with increasing TyG index, regardless of the LVEF level and CHF classification.ConclusionElevated TyG index may be independently associated with more severe clinical left ventricular dysfunction in patients with CHF.

Prognostic Value of Follow-up Measures of Left Ventricular Global Longitudinal Strain in Patients With ST-Segment Elevation Myocardial Infarction

After ST-segment elevation myocardial infarction (STEMI), follow-up imaging is currently recommended only in patients with left ventricular ejection fraction (LVEF)<40%. Left ventricular global longitudinal strain (LVGLS) was shown to improve risk stratification over LVEF in these patients but has not been thoroughly studied during follow-up. The aim of this study was to explore the changes in LVGLS after STEMI and their potential prognostic value. Data were analyzed from an ongoing STEMI registry. Echocardiography was performed during the index hospitalization and 1year after STEMI; LVGLS was expressed as an absolute value and the relative LVGLS change (ΔGLS) was calculated. The study end point was all-cause mortality. A total of 1,409 STEMI patients (age 60±11years; 75% men) who survived at least 1year after STEMI and underwent echocardiography at follow-up were included. At 1-year follow-up, LVEF improved from 50%±8% to 53%±8% (P<.001) and LVGLS from 14%±4% to 16%±3% (P<.001). Median ΔGLS was 14% (interquartile range, 0.5%-32%) relative improvement. Starting 1year after STEMI, a total of 87 patients died after a median follow-up of 69 (interquartile range, 38-103) months. The optimal ΔGLS threshold associated with the end point (derived by spline curve analysis) was a relative decrease >7%. Cumulative 10-year survival was 91% in patients with ΔGLS improvement or a nonsignificant decrease, versus 85% in patients with ΔGLS decrease of >7% (P=.001). On multivariate Cox regression analysis, ΔGLS decrease >7% remained independently associated with the end point (hazard ratio, 2.5 [95% CI, 1.5-4.1]; P<.001) after adjustment for clinical and echocardiographic parameters. A significant decrease in LVGLS 1year after STEMI was independently associated with long-term all-cause mortality and might help further risk stratification and management of these patients during follow-up.

Prognostic value of right ventricular free-wall longitudinal strain in patients with pulmonary hypertension: systematic review and meta-analyses

BackgroundRight ventricular (RV) dysfunction is associated with adverse outcomes in patients with pulmonary hypertension (PH). This systematic review and meta-analysis evaluated the prognostic value of RV free-wall longitudinal strain (RVfwLS),...

The relationship between coronary artery calcium and layer-specific global longitudinal strain in patients with suspected coronary artery disease.

Layer-specific global longitudinal strain (GLS) may provide important insights in patients with suspected coronary artery disease (CAD). We aimed to investigate the association between layer-specific GLS and coronary artery calcium score (CACS) in patients suspected of CAD. We performed a retrospective study of patients suspected of CAD who underwent both an echocardiogram and cardiac computed tomography (median 42 days between). Layer-specific (endocardial-, whole-layer-, and epicardial-) GLS was measured using speckle tracking echocardiography. We assessed the continuous association between layer-specific GLS and CACS by negative binomial regression, and the association with high CACS (≥400) using logistic regression. Of the 496 patients included (mean age 59 years, 56% male), 64 (13%) had a high CACS. Those with high CACS had reduced GLS in all layers compared to those with CACS<400 (endocardial GLS: -20.5vs. -22.7%, whole-layer GLS: -17.7vs. -19.4%, epicardial GLS: -15.3vs. -16.9%, p<.001 for all). Negative binomial regression revealed a significant continuous association showing increasing CACS with worsening GLS in all layers, which remained significant after multivariable adjustment including SCORE chart risk factors. All layers of GLS were associated with high CACS in univariable analyses, which was consistent after multivariable adjustment (endocardial GLS: OR=1.11 (1.03-1.20); whole-layer GLS: OR=1.14 (1.04-1.24); epicardial GLS: OR=1.16 (1.05-1.29), per 1% absolute decrease). In this study population with patients suspected of CAD and normal systolic function, impaired layer-specific GLS was continuously associated with increasing CACS, and decreasing GLS in all layers were associated with presence of high CACS.

Left ventricular longitudinal strain in patients with undifferentiated connective tissue disease and arrhythmia

Aim. To evaluate the left ventricular longitudinal strain in patients with arrhythmia and undifferentiated connective tissue disease (UCTD).Material and methods. This cross-sectional comparative study included young patients with arrhythmia and UCTD (43 men and 84 women; mean age, 30,82±8,17 years (group 1, n=127)). The control group included volunteers with single phenotypic characteristics of UCTD, comparable in age and sex (9 men and 21 women, mean age, 34,13±6,87 years (group 2, n=30)). A standard clinical examination, 72-hour electrocardiographic monitoring, and speckle-tracking echocardiography were performed.Results. Patients of group 1 were characterized by lower global systolic longitudinal myocardial strain compared to the control group: -22,96% [-24,56%; -21,50%] in group 1 vs -24,73% [-25,25%; -23,84%] in group 2 (p=0,016). A local decrease in longitudinal myocardial strain (in two or more segments) was noted in 62,2% of patients in group 1 and 13,3% of patients in group 2 (p=0,025). In group 1, a relationship was revealed between class I premature ventricular contractions (PVCs) and a longitudinal strain decrease in the medial anterior (r1=0,253, p=0,004) and apical anterior (r1=0,253, p=0,004) segments, as well as between class V PVCs and strain decrease in the basal lower (r1=0,215, p=0,021) and middle anterior (r1=0,211, p=0,023) segments. In addition, there was a moderate correlation between mitral valve prolapse (MVP) and a decrease in longitudinal systolic strain in the basal inferolateral (r1=0,405, p=0,041) and basal anterior (r1=0,519, p=0,003) segments.Conclusion. Local decrease in left ventricular longitudinal systolic strain in association with arrhythmia and MVP in patients with UCTD makes it possible to recommend speckle-tracking echocardiography for early non-invasive assessment of myocardial remodeling in this cohort of patients.

Global longitudinal strain in patients with stable angina and myocardial ischemia evaluated by SPECT

Global longitudinal strain in patients with stable angina and myocardial ischemia evaluated by SPECT

Association between the triglyceride–glucose index and left ventricular global longitudinal strain in patients with coronary heart disease in Jilin Province, China: a cross-sectional study

BackgroundThis study aimed to investigate the association between the triglyceride–glucose (TyG) index and left ventricular global longitudinal strain (GLS) in patients with coronary heart disease and to examine the role of left ventricular GLS in detecting early changes in cardiac function in patients with coronary heart disease in the subclinical stage.MethodsA cross-sectional study involving 178 participants with symptomatic coronary artery disease excluding myocardial infarction or left ventricular dysfunction was conducted in Jilin Province, China. Basic clinical, biochemical, and echocardiographic data were obtained from all participants. Myocardial strain parameters were compared between patients with higher TyG index and those with lower TyG index, and the association between the gradually elevated TyG index and on subclinical cardiac function in patients with coronary heart disease was evaluated.ResultsThe GLS of left ventricle was lower in the higher TyG index group than in the lower TyG index group. As the TyG index increases, the GLS progressively decreases. The results remained stable after adjusting for confounding factors.ConclusionsA higher TyG index maybe independently associated with subclinical left ventricular dysfunction in patients with coronary heart disease.

Assessment of left ventricular global longitudinal strain in patients with hypertrophic cardiomyopathy and coronary artery disease.

Impaired left ventricular global longitudinal strain (GLS) and coronary artery disease (CAD) each confer adverse prognosis in hypertrophic cardiomyopathy (HCM). Despite their prevalence, data on GLS in co-existent HCM and CAD is lacking.Ninety-six patients with HCM and CAD were retrospectively identified between 2005 and 2021, and analyzed using 2D speckle-tracking echocardiography. Obstructive and non-obstructive CAD patients were compared, multivariate linear regression tested associations between clinical and echocardiographic variables with GLS, and Receiver Operating Characteristic Curve assessed the utility of GLS to predict all-cause mortality at follow-up.Mean age was 71 ± 12.2 years, 41% had obstructive HCM, 78% had obstructive CAD, and 75% had prior acute coronary syndrome. At 4.8-year follow-up, GLS decreased compared with baseline (- 12.5 ± 4.5 vs. - 14 ± 4.2%, p = 0.007), with basal segments experiencing the greatest impairment. GLS was lower in obstructive versus non-obstructive CAD patients at follow-up, although the magnitude was attenuated (baseline: - 13.2 vs. - 17.1%, p < 0.001; follow-up: - 12 vs. - 14.1%, p = 0.05). Interventricular septal thickness (β = 0.54), apical HCM (β = 0.48), and right ventricular systolic pressure (β = 0.39) were associated with more impaired GLS (all p < 0.001), independent of obstructive CAD (β = 0.09, p = 0.44). There were 9 follow-up deaths, with baseline GLS > - 13.5% being a good predictor of all-cause mortality (AUC 0.78, 95% CI 0.64-0.92, sensitivity 88%, specificity 57%, p = 0.01).Patients with HCM and CAD experience progressive GLS impairment over long-term follow-up, with GLS > - 13.5% appearing to be a threshold for predicting all-cause mortality. Apical HCM phenotype is independently associated with worse GLS.

The characteristics of Left atrial longitudinal strain in patients with cryptogenic stroke using Speckle Tracking Echocardiography- A case control study

The characteristics of Left atrial longitudinal strain in patients with cryptogenic stroke using Speckle Tracking Echocardiography- A case control study

Speckle tracking echocardiographic assessment of Left ventricular global longitudinal strain in patients recovered from COVID-19

Speckle tracking echocardiographic assessment of Left ventricular global longitudinal strain in patients recovered from COVID-19

Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial.

Background Left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information over LV ejection fraction in patients with heart failure (HF) and secondary mitral regurgitation. We examined the prognostic impact of LV GLS improvement in this population. Methods and Results The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial randomized symptomatic patients with HF with severe (3+/4+) mitral regurgitation to transcatheter edge-to-edge repair with the MitraClip device plus maximally tolerated guideline-directed medical therapy (GDMT) versus GDMT alone. LV GLS was measured at baseline and 6-month follow-up. The relationship between the improvement in LV GLS from baseline to 6 months and the composite of all-cause death or HF hospitalization between 6- and 24-month follow-up were assessed. Among 383 patients, 174 (45.4%) had improved LV GLS at 6-month follow-up (83/195 [42.6%] with transcatheter edge-to-edge repair+GDMT and 91/188 [48.4%] with GDMT alone; P=0.25). Improvement in LV GLS was strongly associated with reduced death or HF hospitalization between 6 and 24 months (P<0.009), with similar risk reduction in both treatment arms (Pinteraction=0.40). By multivariable analysis, LV GLS improvement at 6 months was independently associated with a lower risk of death or HF hospitalization (hazard ratio [HR], 0.55 [95% CI, 0.36-0.83]; P=0.009), death (HR, 0.48 [95% CI, 0.29-0.81]; P=0.006), and HF hospitalization (HR, 0.50 [95% CI, 0.31-0.81]; P=0.005) between 6 and 24 months. Conclusions Among patients with HF and severe mitral regurgitation in the COAPT trial, improvement in LV GLS at 6-month follow-up was associated with improved outcomes after both transcatheter edge-to-edge repair and GDMT alone between 6 and 24 months. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.

Left ventricular longitudinal strain in patients with type 2 diabetes mellitus is independently associated with glycated hemoglobin level.

Left ventricular and left atrial strain are sensitive and reliable markers for evaluating cardiac function in patients with type 2 diabetes mellitus (T2DM), with interactions between the two parameters. The present study aimed to analyze the correlation between global longitudinal strain (GLS) of the left ventricle and glycated hemoglobin (HbA1c) levels in patients with T2DM. A total of 292 patients clinically diagnosed with T2DM were selected and divided into three groups according to HbA1c level. The strains of the left atrium and left ventricle in the three groups of T2DM patients with different HbA1c levels were compared. Univariate and multivariate (including left atrial functional indicators) linear regression analyses were performed to assess the relationship between strain indicators and HbA1c levels. Generalized additive models were used to examine the relationship between strain indicators and HbA1c levels. There were significant differences among the three groups in terms of age, microalbuminuria, total cholesterol, fasting blood glucose, postprandial blood glucose, and HbA1c level, and left atrial conduit longitudinal strain (LAScd) and GLS (p < .05). Univariate and multivariate linear regression analyses revealed that, as HbA1c levels increased, the absolute value of GLS gradually decreased (p < .001). Curve fitting revealed a positive correlation between HbA1c level and GLS, which was not affected by left atrial function. Left ventricular GLS was independently correlated with HbA1c level in patients with T2DM and was not affected by left atrial function.

Echocardiographic Study of Global Longitudinal Strain in Patients with Bipolar Disorder and Schizophrenia

Echocardiographic Study of Global Longitudinal Strain in Patients with Bipolar Disorder and Schizophrenia

Topographical Association Between Left Ventricular Strain and Brain Lesions in Patients With Acute Ischemic Stroke and Normal Cardiac Function.

Background Although it is well known that the disordered brain provokes cardiac autonomic dysfunction, the detailed location of brain lesions related to cardiac function warrants further investigation. We aimed to elucidate the brain lesions topographically associated with left ventricular (LV) systolic function measured by myocardial strain in patients with acute ischemic stroke without preexisting primary cardiac dysfunction by using support vector regression lesion-symptom mapping. Methods and Results Subjects were those with LV ejection fraction of 50% or more among patients with acute ischemic stroke registered in the Samsung Medical Center stroke registry between 2016 and 2017. To evaluate LV systolic performance and contractility, we measured LV ejection fraction and LV global and regional longitudinal strain using 2-dimensional speckle-tracking echocardiography. The association between stroke lesion location and cardiac strain was assessed using support vector regression lesion-symptom mapping. Of a total of 776 patients, 286 subjects (mean age of 67.0 years, 65.4% men) were finally enrolled in this study. The mean global longitudinal strain was -17.0±3.4%, and the mean LV ejection fraction was 64.7±5.7%. The support vector regression lesion-symptom mapping analysis revealed that the right insula and peri-insular regions and left parietal cortex were associated with impaired LV global longitudinal strain in patients with acute ischemic stroke. In addition, impaired regional longitudinal strain showed topographical associations with these regions. Conclusions This study suggests that brain lesions in the right insula and peri-insular regions and left parietal cortex are topographically associated with impaired LV strain in patients with acute ischemic stroke without preexisting cardiac dysfunction.

Left ventricular strain echocardiography in advanced uremic cardiomyopathy compared to dilated cardiomyopathy

BackgroundCardiac involvement is common in end-stage renal disease patients. The presenting study aimed to evaluate the global and segmental longitudinal strain in patients with advanced uremic cardiomyopathy (AUCM) and compare it to dilated cardiomyopathy (DCM).ResultsThe mean global longitudinal strain (GLS) was significantly lower in AUCM (P value = 0.045). Comparing segmental strain showed a lower strain in mid inferoseptal (P value = 0.048), base and mid anterolateral (P value = 0.026, 0.001 respectively), base and mid anteroseptal (P value = 0.005, 0.009 respectively), base and mid inferior (P value = 0.015, 0.034 respectively) and mid anterior (P value = 0.015) in patients with AUCM compared with DCM. In both groups, the segmental strain increased from base to apex.ConclusionsSegmental and GLSs in advanced uremic cardiomyopathy were significantly lower than those of dilated cardiomyopathy. In both groups, the segmental strain increased from base to apex.

Prognostic Relevance of Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Reduced Ejection Fraction

Patients with heart failure (HF) and reduced ejection fraction (HFrEF) are complex patients who often have a high prevalence of co-morbidities and risk factors. In the present study, we investigated the prognostic significance of left ventricular (LV) global longitudinal strain (GLS) along with importantclinical and echocardiographic variables in patients with HFrEF. Patients who had a first echocardiographic diagnosis of LV systolic dysfunction, defined as LV ejection fraction ≤45%, were selected. The study population was subdivided into 2 groups based on a spline curve analysis derived optimal threshold value of LV GLS (≤10%). The primary end point was occurrence of worsening HF, whereas the composite of worsening HF and all-cause death was chosen for the secondary end point. A total of 1,873 patients (mean age 63±12years, 75% men) were analyzed. During a median follow-up of 60months (interquartile range 27 to 60months), 256 patients (14%) experienced worsening HF and the composite end point of worsening HF and all-cause mortality occurred in 573 patients (31%). The 5-year event-free survival rates for the primary and secondary end point were significantly lower in the LV GLS ≤10% group compared with the LV GLS >10% group. After adjustment for important clinical and echocardiographic variables, baseline LV GLS remained independently associated with a higher risk of worsening HF (hazard ratio0.95, 95% confidence interval 0.90 to 0.99, p=0.032) and the composite of worsening HF and all-cause mortality (hazard ratio0.94, 95% confidence interval 0.90 to 0.97, p=0.001). In conclusion, baseline LV GLS is associated with long-term prognosis in patients with HFrEF, independent of various clinical and echocardiographic predictors.

Effect of hypertriglyceridemia on left ventricular global longitudinal strain in patients with coronary heart disease in Jilin Province, China: a cross-sectional study.

Using speckle tracking technology to investigate the effect of hypertriglyceridemia on the global longitudinal strain(GLS) of the left ventricle in patients with coronary heart disease in the early stage, and to explore the value of myocardial strain in early identification of cardiac dysfunction in patients with coronary heart disease in the pre-heart failure stage. A cross-sectional study of 138 participants was conducted in Jilin Province, China. Basic clinical, biochemical, and echocardiographic data were obtained for all patients. Myocardial strain parameters were compared between the hypertriglyceridemia and normal triglyceride level groups and the effect of hypertriglyceridemia on early left ventricular global longitudinal strain impairment in coronary heart disease patients was evaluated. The overall longitudinal strain of the left ventricle was smaller in the hypertriglyceridemia group than in the normal triglyceride group. After the multivariate Logistic regression model adjusting for the influence of confounding factors, the results remained stable. The risk of impairment of global longitudinal strain of the left ventricle in patients with coronary heart disease is positively correlated with triglyceride levels, and hypertriglyceridemia maybe an independent risk factor affecting early cardiac dysfunction in the pre-heart failure stage of patients with coronary heart disease.

The Association Between Blood Pressure Control and Global Longitudinal Strain in Patients With HER2-Positive Breast Cancer on Trastuzumab-Based Regimens

The Association Between Blood Pressure Control and Global Longitudinal Strain in Patients With HER2-Positive Breast Cancer on Trastuzumab-Based Regimens

Assessment of LV Function by Global Longitudinal Strain in Patients with Chronic Kidney Disease

Assessment of LV Function by Global Longitudinal Strain in Patients with Chronic Kidney Disease