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Prognostic utility of blood pressure-adjusted global and basal systolic longitudinal strain

Echo Research & Practice volume 3, pages 17–24 (2016)Cite this article

Abstract

Assessment of global longitudinal systolic strain (GLS) and longitudinal systolic strain of the basal segments (BLS) has shown prognostic value in cardiac disorders. However, strain is reduced with increased afterload. We assessed the prognostic value of GLS and BLS adjusted for afterload. GLS and BLS were determined in 272 subjects with normal ejection fraction and no known coronary disease, or significant valve disease. Systolic blood pressure (SP) and diastolic blood pressure (DP) obtained at the time of echocardiography were used to adjust GLS and BLS as follows: strain×P (mmHg)/120 mmHg and strain×P (mmHg)/80 mmHg. Patients were followed for cardiac events and mortality. The mean age was 53±15 years and 53% had hypertension. There were 19 cardiac events and 70 deaths over a mean follow-up of 26±14 months. Cox analysis showed that left ventricular mass index (P=0.001), BLS (P<0.001), and DP-adjusted BLS (P<0.001) were independent predictors of cardiac events. DP-adjusted BLS added incremental value (P<0.001) to the other two predictors and had an area under the curve of 0.838 for events. DP (P=0.001), age (P=0.001), ACE inhibitor use (P=0.017), and SP-adjusted BLS (P=0.012) were independent predictors of mortality. SP-adjusted BLS added incremental value (P=0.014) to the other independent predictors. In conclusion, DP-adjusted BLS and SP-adjusted BLS were independent predictors of cardiac events and mortality, respectively. Blood pressure-adjusted strain added incremental prognostic value to other predictors of outcome.

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Funding

This project was funded by the Indiana University School of Medicine Strategic Research Initiative.

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Authors and Affiliations

  1. Case Western Reserve University, Cleveland, Ohio, USA

    Isaac B. Rhea MD & Stephen G. Sawada MD

  2. Tulane Heart and Vascular Institute, Tulane University, New Orleans, Louisiana, USA

    Shuja Rehman MD

  3. Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA

    Upasana Jarori MD, Harvey Feigenbaum MD & Stephen G. Sawada MD

  4. University of Texas Medical Branch, Galveston, Texas, USA

    Muhammad W. Choudhry MD

Authors
  1. Isaac B. Rhea MD
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  2. Shuja Rehman MD
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  3. Upasana Jarori MD
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  4. Muhammad W. Choudhry MD
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  5. Harvey Feigenbaum MD
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  6. Stephen G. Sawada MD
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Corresponding authors

Correspondence to Upasana Jarori MD or Stephen G. Sawada MD.

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Rhea, I.B., Rehman, S., Jarori, U. et al. Prognostic utility of blood pressure-adjusted global and basal systolic longitudinal strain. Echo Res Pract 3, 17–24 (2016). https://doi.org/10.1530/ERP-15-0037

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Echo Research & Practice

ISSN: 2055-0464

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