Impact of longitudinal myocardial deformation on the prognosis of chronic heart failure patients.
BACKGROUND
Longitudinal myocardial deformation indexes appear superior to left ventricular ejection fraction (LVEF) in assessing myocardial contractility. However, few studies have addressed the prognostic value of longitudinal motion markers (velocity, strain, and strain rate) in predicting outcome in heart failure patients.


RESULTS
The study included 125 consecutive symptomatic heart failure patients (63+/-16 years, 77% male, LVEF=31+/-10%). All patients underwent a complete echocardiographic and clinical examination, and brain natriuretic peptide level was assessed in 93 patients. Longitudinal myocardial velocity by tissue Doppler imaging, global-epsilon, and strain rate by speckle tracking were computed from apical views (4-, 3-, and 2-chambers views) and compared with the occurrence of major adverse cardiac events. On the whole, peak longitudinal velocity, global-epsilon, and strain rate averaged 5+/-2 cm/s (range, 1 to 9), -8+/-3% (range, -3 to -18), and -0.33+/-0.16 s(-1) (range, -0.83 to -0.05), respectively. During the follow-up period (266+/-177 days), major adverse cardiac events occurred in 47 (38%) patients (15 deaths, 29 recurrent heart failure, and 4 heart transplantations). By univariable analysis using Cox model global-epsilon, strain rate, and LVEF were associated with the occurrence of major adverse cardiac events, whereas only global-epsilon remained independently predictive of outcome by multivariate analysis.


CONCLUSIONS
In the heart failure population, longitudinal global strain by speckle tracking is superior to LVEF and other longitudinal markers in identifying patients with poor outcome.
APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France.
Julien
J
Nahum
Alexandre
A
Bensaid
Caroline
C
Dussault
Laurent
L
Macron
Darrort
D
Clémence
Belaid
B
Bouhemad
Jean-Luc
JL
Monin
Jean-Luc Dubois
JL
Rande
Pascal
P
Gueret
Pascal
P
Lim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging*; D006334:Heart Function Tests; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D020097:Natriuretic Peptide, Brain / Q000097:blood; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*; D055815:Young Adult
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain