ABSTRACT
BACKGROUND: Several studies have demonstrated the importance of left ventricular (LV) global longitudinal strain (GLS) as a reliable prognostic indicator in patients with heart failure (HF). These studies have included few African American (AA) patients, despite the growing prevalence and severity of HF in this patient population. HYPOTHESIS: LV GLS predicts long-term HF admission and all-cause mortality in AA patients with chronic HF on optimal guideline-directed medical therapy (GDMT). METHODS: We enrolled 207 AA adults, age 56 ± 14.5 years, with New York Heart Association (NYHA) class I through III HF on optimal GDMT from the University of Illinois HF clinic between November 2001 and February 2014. LV GLS was assessed by velocity vector imaging using 2-, 3-, and 4-chamber views. Patients were followed for HF admissions and death for 3 ± 3.0 years. LV GLS value of -7.95 was used as the optimal cutoff point that maximizes sensitivity and specificity RESULTS: LV GLS < -7.95% was significantly associated with higher all-cause mortality and HF admissions in Kaplan-Meier survival curves (log-rank P < 0.001). After incorporation in multivariate Cox proportional hazard models, GLS < -7.95% was found to be an independent predictor of all-cause mortality (hazard ratio [HR] = 4.04; 95% confidence interval [CI]: 1.07-15.32; P = 0.04] and HF admissions (HR = 3.86; 95% CI: 1.38-10.77; P = 0.010). CONCLUSIONS: In AA patients with chronic stable HF on GDMT, more impaired LV GLS (< -7.95%) is a strong and independent predictor of long-term all-cause mortality and HF admissions.
Subject(s)
Black or African American , Heart Failure/mortality , Heart Failure/physiopathology , Hospitalization , Myocardial Contraction , Stroke Volume , Ventricular Dysfunction, Left/mortality , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left , Adult , Aged , Biomechanical Phenomena , Cause of Death , Chi-Square Distribution , Chicago , Comorbidity , Female , Heart Failure/diagnostic imaging , Heart Failure/ethnology , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Prognosis , Proportional Hazards Models , Risk Assessment , Risk Factors , Stress, Mechanical , Time Factors , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/ethnologyABSTRACT
BACKGROUND: The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure. METHODS AND RESULTS: Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 ± 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p < 0.001). After adjusting for age, sex, history of ischemic heart disease, dementia, New York Heart Association class, LV ejection fraction, use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, systolic and diastolic blood pressure on admission and sodium level on admission, worse LV GLS was the strongest predictor of recurrent HF readmission (p < 0.001). The ejection fraction was predictive of readmission in univariate, but not in multivariate analysis. CONCLUSION: LV GLS is an independent predictor of HF readmission after acute decompensated heart failure with a higher risk of readmission in case of progressive worsening of LV GLS, independent of the ejection fraction.
