Abstract 15940: Prognostic Value of Left Ventricular Global Longitudinal Strain in the Elderly: A Population-Based Prospective Cohort Study
Background: Left ventricular (LV) global longitudinal strain (GLS) is a measure of LV systolic function that can detect subclinical abnormalities in cardiac function, even if LV ejection fraction (LVEF) is in the normal range. GLS is associated with cardiovascular events in selected populations at high cardiovascular risk, however whether GLS carries prognostic information in a general elderly population is unknown.
Methods: Stroke-free participants were enrolled in the Cardiovascular Abnormalities and Brain Lesions (CABL) study as a sub-study of the Northern Manhattan Study (NOMAS), a population-based prospective cohort study. Study participants underwent two-dimensional transthoracic echocardiography, with assessment of LVEF by biplane Simpson’s rule and of GLS by speckle-tracking. Annual follow-up was performed for incident cardiovascular events (ischemic stroke, myocardial infarction, and vascular death). Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for outcome prediction.
Results: Mean age of the study sample (n=708) was 71±9 years, 61% were women, LVEF was 63±7%, GLS was -17±3%. Hypertension was present in 77%, diabetes in 27%, history of coronary artery disease in 5%, atrial fibrillation in 2% of participants. During a mean follow-up of 4.7±1.5 years, 55 events were recorded. In univariate analyses, both LVEF (HR/unit increase=0.95, 95% CI=0.93-0.98, p=0.0007) and GLS (HR/unit decrease=1.22, 95% CI=1.12-1.32, p<0.0001) were significantly associated with future events. In analyses adjusted for age, sex, hypertension, coronary artery disease, atrial fibrillation, and LV mass, a lower GLS remained a significant predictor of incident events (HR/unit decrease=1.12, 95% CI=1.03-1.22, p=0.009) whereas LVEF did not (HR/unit increase=0.98, 95% CI=0.95-1.01, p=0.12). The association of GLS with outcome persisted even after including LVEF in the multivariate model.
Conclusion: In our community-based elderly cohort, GLS was an independent predictor of a combined cardiovascular outcome, while LVEF was not. LV function assessment by GLS may improve cardiovascular risk stratification in the elderly.
- © 2013 by American Heart Association, Inc.