Echocardiographic Global Longitudinal Strain Is Associated With Myocardial Fibrosis and Predicts Outcomes in Aortic Stenosis

T.T. le; Huang, W.T.; Singh, G.K.; Toh, D.F.; Ewe, S.H.; Tang, H.C.; ... ; Chin, C.W.L. (2021)

Article / Letter to editor

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 chi(2) = 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.

• myocardial fibrosis
• cardiovascular magnetic resonance
• global longitudinal strain (GLS)
• aortic stenosis (AS)
• hypertensive heart disease (HHD)

• All authors: T.T. le; Huang, W.T.; Singh, G.K.; Toh, D.F.; Ewe, S.H.; Tang, H.C.; Loo, G.; Bryant, J.A.; Ang, B.; Tay, E.L.W.; Soo, W.M.; Yip, J.W.L.; Oon, Y.Y.; Gong, L.L.; Lunaria, J.B.; Yong, Q.W.; Lee, E.M.; Yeo, P.S.D.; Chai, S.C.; Goh, P.P.; Ling, L.F.; Ong, H.Y.; Richards, A.M.; Delgado, V.; Bax, J.J.; Ding, Z.P.; Ling, L.H.; Chin, C.W.L.
• Date: 2021-11-10
• Journal: Frontiers in Cardiovascular Medicine
• Volume: 8
• DOI: doi:10.3389/fcvm.2021.750016