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Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring
Citation
Stanton, T and Leano, R and Marwick, TH, Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring, Circulation: Cardiovascular Imaging, 288, (5) pp. 356-364. ISSN 1941-9651 (2009) [Refereed Article]
Copyright Statement
Copyright 2009 American Heart Association, Inc.
DOI: doi:10.1161/circimaging.109.862334
Abstract
Background—Although global left ventricular systolic function is an important determinant of mortality, standard
measures such as ejection fraction (EF) and wall motion score index (WMSI) have important technical limitations. The
aim of this study was to compare global longitudinal speckle strain (GLS), an automated technique for measurement of
long-axis function, with EF and WMSI for the prediction of mortality.
Methods and Results—Of 546 consecutive individuals undergoing echocardiography for assessment of resting left ventricular function, 91 died over a period of 5.2±1.5 years. In addition to Simpson biplane EF, WMSI was determined by 2 experienced readers and GLS was calculated from 3 standard apical views using 2D speckle tracking. The incremental value of EF, WMSI, and GLS to significant clinical variables was assessed in nested Cox models. Clinical factors associated with outcome (model χ2=20.2) were age (hazard ratio [HR], 1.46; P<0.01), diabetes (HR, 1.88; P=0.01), and hypertension (HR, 1.59; P<0.05). Although addition of EF (HR, 1.23; P=0.03) or WMSI (HR, 1.28; P<0.01) added to the predictive power of clinical variables, the addition of GLS (HR, 1.45; P<0.001) caused the greatest increment in model power (χ2=34.9, P<0.001). GLS also provided incremental value in subgroups with EF >35% and those with and without wall motion abnormalities. A GLS ≥-12% was found to be equivalent to an EF ≤35% for the prediction of prognosis. Intraobserver and interobserver variations for EF and GLS were similar.
Conclusions—GLS is a superior predictor of outcome to either EF or WMSI and may become the optimal method for assessment of global left ventricular systolic function.
Methods and Results—Of 546 consecutive individuals undergoing echocardiography for assessment of resting left ventricular function, 91 died over a period of 5.2±1.5 years. In addition to Simpson biplane EF, WMSI was determined by 2 experienced readers and GLS was calculated from 3 standard apical views using 2D speckle tracking. The incremental value of EF, WMSI, and GLS to significant clinical variables was assessed in nested Cox models. Clinical factors associated with outcome (model χ2=20.2) were age (hazard ratio [HR], 1.46; P<0.01), diabetes (HR, 1.88; P=0.01), and hypertension (HR, 1.59; P<0.05). Although addition of EF (HR, 1.23; P=0.03) or WMSI (HR, 1.28; P<0.01) added to the predictive power of clinical variables, the addition of GLS (HR, 1.45; P<0.001) caused the greatest increment in model power (χ2=34.9, P<0.001). GLS also provided incremental value in subgroups with EF >35% and those with and without wall motion abnormalities. A GLS ≥-12% was found to be equivalent to an EF ≤35% for the prediction of prognosis. Intraobserver and interobserver variations for EF and GLS were similar.
Conclusions—GLS is a superior predictor of outcome to either EF or WMSI and may become the optimal method for assessment of global left ventricular systolic function.
Item Details
| Item Type: | Refereed Article |
|---|---|
| Keywords: | echocardiography, ventricular function, strain, mortality |
| Research Division: | Biomedical and Clinical Sciences |
| Research Group: | Cardiovascular medicine and haematology |
| Research Field: | Cardiology (incl. cardiovascular diseases) |
| Objective Division: | Health |
| Objective Group: | Clinical health |
| Objective Field: | Clinical health not elsewhere classified |
| UTAS Author: | Marwick, TH (Professor Tom Marwick) |
| ID Code: | 90761 |
| Year Published: | 2009 |
| Web of Science® Times Cited: | 518 |
| Deposited By: | Menzies Institute for Medical Research |
| Deposited On: | 2014-04-23 |
| Last Modified: | 2014-05-16 |
| Downloads: | 0 |
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