Left Ventricular Strain and Clinical Outcomes
Association Between Global Longitudinal Strain and Cardiovascular Events in Patients With Left Bundle Branch Block Assessed Using Two-Dimensional Speckle-Tracking Echocardiography

https://doi.org/10.1016/j.echo.2017.08.016Get rights and content

Highlights

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    LV GLS is a powerful prognostic factor and detects subtle LV dysfunction.

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    The authors assessed the association between LV GLS and cardiovascular events in patients with LBBB.

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    Impaired GLS had a significant association with cardiovascular events in patients with LBBB.

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    The association between LV GLS and cardiovascular events was significant regardless of LVEF values.

  • •

    LV GLS may provide better risk stratification than LVEF in patients with LBBB.

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.

Section snippets

Study Population

We retrospectively identified 329 consecutive individuals with LBBB, who underwent 2D echocardiography at Seoul National University Bundang Hospital between July 2009 and August 2015. We excluded those who had undergone heart surgery before the index echocardiographic examination (n = 14) and those with atrial fibrillation (n = 31). We also excluded those with poor image quality for strain measurements (n = 15). Finally, we included 269 patients with LBBB and with adequate image quality for

Baseline Characteristics

Table 2 shows the baseline characteristics of the study population, divided according to the occurrence of the composite end point. The mean age was 69.5 ± 10.9 years, and 46.8% were men. During a median of 27.5 months (interquartile range, 12.8–43.9 months) of follow-up, 55 patients (20.4%) had composite end points, including cardiovascular mortality (n = 12 [4.5%]) and hospitalization for HF (n = 51 [19.0%]). Twenty-nine patients (10.8%) underwent CRT during follow-up, and these patients were

Discussion

We showed that impaired LV GLS measured by 2D STE has a significant and independent association with the occurrence of cardiovascular events in patients with LBBB. The association between impaired GLS and higher cardiovascular risk was significant in both subgroups: those with reduced and those with preserved LVEFs. Furthermore, the addition of GLS to clinical risk factors and other echocardiographic parameters resulted in a significant improvement in the association between clinical risk

Conclusions

LV GLS assessed by 2D STE had a significant association with cardiovascular events in patients with LBBB. The association of GLS with cardiovascular events was more significant compared with LVEF and was noted to be significant in both subgroups of patients with reduced and preserved LVEFs. Our findings suggest the potential of GLS measurement for risk stratification in patients with LBBB.

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    Conflicts of Interest: None.

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    2017 by the American Society of Echocardiography.