Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis
Aims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:37b8daa04d294780834082407c9dffba2021-11-10T06:59:27ZEchocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis2297-055X10.3389/fcvm.2021.750016https://doaj.org/article/37b8daa04d294780834082407c9dffba2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.750016/fullhttps://doaj.org/toc/2297-055XAims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on cardiovascular magnetic resonance (CMR) and validate the prognostic value of LV-GLS thresholds associated with fibrosis.Methods and results: LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57 ± 10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71 ± 12 years; 58% males; NYHA functional class I–II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, and myocardial infarction. In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74 [0.66–0.83]; P < 0.001) and calibration (Hosmer-Lemeshow χ2 = 6.37; P = 0.605) for replacement fibrosis. In the outcome cohort, 47 events occurred over 16 [3.3, 42.2] months. Patients with LV-GLS > −15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS < −21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P < 0.001). LV-GLS offered independent prognostic value over clinical variables, AS severity and echocardiographic LV mass and E/e′.Conclusion: LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF.Thu-Thao LeThu-Thao LeWeiting HuangWeiting HuangGurpreet K. SinghDesiree-Faye TohSee Hooi EweSee Hooi EweHak Chaw TangHak Chaw TangGermaine LooJennifer A. BryantBriana AngEdgar Lik-Wui TayEdgar Lik-Wui TayWern Miin SooJames Wei-Luen YipYen Yee OonLingli GongJosephien B. LunariaQuek Wei YongEvelyn Min LeePoh Shuan Daniel YeoPoh Shuan Daniel YeoSiang Chew ChaiPing Ping GohLee Fong LingHean Yee OngArthur Mark RichardsArthur Mark RichardsArthur Mark RichardsArthur Mark RichardsVictoria DelgadoJeroen J. BaxZee Pin DingZee Pin DingLieng-Hsi LingLieng-Hsi LingLieng-Hsi LingCalvin W. L. ChinCalvin W. L. ChinCalvin W. L. ChinFrontiers Media S.A.articlemyocardial fibrosiscardiovascular magnetic resonanceglobal longitudinal strain (GLS)aortic stenosis (AS)hypertensive heart disease (HHD)Diseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021) |
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EN |
| topic |
myocardial fibrosis cardiovascular magnetic resonance global longitudinal strain (GLS) aortic stenosis (AS) hypertensive heart disease (HHD) Diseases of the circulatory (Cardiovascular) system RC666-701 |
| spellingShingle |
myocardial fibrosis cardiovascular magnetic resonance global longitudinal strain (GLS) aortic stenosis (AS) hypertensive heart disease (HHD) Diseases of the circulatory (Cardiovascular) system RC666-701 Thu-Thao Le Thu-Thao Le Weiting Huang Weiting Huang Gurpreet K. Singh Desiree-Faye Toh See Hooi Ewe See Hooi Ewe Hak Chaw Tang Hak Chaw Tang Germaine Loo Jennifer A. Bryant Briana Ang Edgar Lik-Wui Tay Edgar Lik-Wui Tay Wern Miin Soo James Wei-Luen Yip Yen Yee Oon Lingli Gong Josephien B. Lunaria Quek Wei Yong Evelyn Min Lee Poh Shuan Daniel Yeo Poh Shuan Daniel Yeo Siang Chew Chai Ping Ping Goh Lee Fong Ling Hean Yee Ong Arthur Mark Richards Arthur Mark Richards Arthur Mark Richards Arthur Mark Richards Victoria Delgado Jeroen J. Bax Zee Pin Ding Zee Pin Ding Lieng-Hsi Ling Lieng-Hsi Ling Lieng-Hsi Ling Calvin W. L. Chin Calvin W. L. Chin Calvin W. L. Chin Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis |
| description |
Aims: Left ventricular ejection fraction is the conventional measure used to guide heart failure management, regardless of underlying etiology. Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) is a more sensitive measure of intrinsic myocardial function. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on cardiovascular magnetic resonance (CMR) and validate the prognostic value of LV-GLS thresholds associated with fibrosis.Methods and results: LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57 ± 10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71 ± 12 years; 58% males; NYHA functional class I–II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, and myocardial infarction. In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74 [0.66–0.83]; P < 0.001) and calibration (Hosmer-Lemeshow χ2 = 6.37; P = 0.605) for replacement fibrosis. In the outcome cohort, 47 events occurred over 16 [3.3, 42.2] months. Patients with LV-GLS > −15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS < −21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P < 0.001). LV-GLS offered independent prognostic value over clinical variables, AS severity and echocardiographic LV mass and E/e′.Conclusion: LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF. |
| format |
article |
| author |
Thu-Thao Le Thu-Thao Le Weiting Huang Weiting Huang Gurpreet K. Singh Desiree-Faye Toh See Hooi Ewe See Hooi Ewe Hak Chaw Tang Hak Chaw Tang Germaine Loo Jennifer A. Bryant Briana Ang Edgar Lik-Wui Tay Edgar Lik-Wui Tay Wern Miin Soo James Wei-Luen Yip Yen Yee Oon Lingli Gong Josephien B. Lunaria Quek Wei Yong Evelyn Min Lee Poh Shuan Daniel Yeo Poh Shuan Daniel Yeo Siang Chew Chai Ping Ping Goh Lee Fong Ling Hean Yee Ong Arthur Mark Richards Arthur Mark Richards Arthur Mark Richards Arthur Mark Richards Victoria Delgado Jeroen J. Bax Zee Pin Ding Zee Pin Ding Lieng-Hsi Ling Lieng-Hsi Ling Lieng-Hsi Ling Calvin W. L. Chin Calvin W. L. Chin Calvin W. L. Chin |
| author_facet |
Thu-Thao Le Thu-Thao Le Weiting Huang Weiting Huang Gurpreet K. Singh Desiree-Faye Toh See Hooi Ewe See Hooi Ewe Hak Chaw Tang Hak Chaw Tang Germaine Loo Jennifer A. Bryant Briana Ang Edgar Lik-Wui Tay Edgar Lik-Wui Tay Wern Miin Soo James Wei-Luen Yip Yen Yee Oon Lingli Gong Josephien B. Lunaria Quek Wei Yong Evelyn Min Lee Poh Shuan Daniel Yeo Poh Shuan Daniel Yeo Siang Chew Chai Ping Ping Goh Lee Fong Ling Hean Yee Ong Arthur Mark Richards Arthur Mark Richards Arthur Mark Richards Arthur Mark Richards Victoria Delgado Jeroen J. Bax Zee Pin Ding Zee Pin Ding Lieng-Hsi Ling Lieng-Hsi Ling Lieng-Hsi Ling Calvin W. L. Chin Calvin W. L. Chin Calvin W. L. Chin |
| author_sort |
Thu-Thao Le |
| title |
Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis |
| title_short |
Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis |
| title_full |
Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis |
| title_fullStr |
Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis |
| title_full_unstemmed |
Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis |
| title_sort |
echocardiographic global longitudinal strain is associated with myocardial fibrosis and predicts outcomes in aortic stenosis |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/37b8daa04d294780834082407c9dffba |
| work_keys_str_mv |
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