Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure

ObjectivesWe sought to evaluate whether global 2-dimensional (2D) strain offers additional benefit over left ventricular ejection fraction (LVEF) to predict clinical events in heart failure.BackgroundAlthough 2D strain based on speckle tracking has been proposed as a simple and reproducible tool to detect systolic dysfunction, the relationship of 2D strain and prognosis has not been studied.MethodsTwo hundred one patients (age 63 ± 11 years, 34% female, LVEF 34 ± 13%) hospitalized for acute heart failure underwent clinical evaluation and conventional and tissue Doppler echocardiography. Using dedicated software, we measured the global longitudinal strain (GLS) in apical 4- and 2-chamber views and the global circumferential strain (GCS) in a parasternal short-axis view. Cardiac events were defined as readmission for heart failure or cardiac death.ResultsThere were 23.4% clinical events during 39 ± 17 months of follow-up. In univariate analysis, age, left atrial volume, left ventricular volume, LVEF, ratio of early transmitral flow to early diastolic annular velocity (E/e′), and both GLS and GCS were predictive of cardiac events. In multivariate Cox models, age (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01 to 1.10, p = 0.017) and GCS (HR: 1.15, 95% CI: 1.04 to 1.28; p = 0.006) were independently associated with cardiac events. By Cox proportional hazards model, the addition of GCS markedly improved the prognostic utility of a model containing ejection fraction, E/e′, and GLS.ConclusionsGCS is a powerful predictor of cardiac events and appears to be a better parameter than ejection fraction in patients with acute heart failure.