Global longitudinal strain corrected by RR-interval is a superior echocardiographic predictor of outcome in patients with atrial fibrillation. (15th July 2018)

• Record Type: Journal Article
• Authors: Dons, Maria; Jensen, Jan Skov; Olsen, Flemming Javier; de Knegt, Martina Chantal; Fritz-Hansen, Thomas; Vazir, Ali; Biering-Sørensen, Tor
• Is Part Of: International journal of cardiology. Volume 263(2018)
• Page Start: 42
• Page End: 47
• Publication Date: 2018-07-15
• Subjects: AF atrial fibrillation -- GLS global longitudinal strain -- HF heart failure -- RR RR-interval -- LVEF left ventricular ejection fraction -- LA left atrium -- LV left ventricle -- TDI tissue Doppler imaging -- DM diabetes mellitus -- FR frame rate -- FPS frames per second -- bpm beats per minute -- TTE transthoracic echocardiography -- SR strain rate; Echocardiography -- Speckle tracking -- Strain -- Atrial fibrillation -- Outcome -- Mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2018.02.038
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Echocardiographic assessment of systolic and diastolic function during atrial fibrillation (AF) is challenging. This study evaluates the prognostic value of strain in patients with AF and suggests a novel approach on how to take into account the varying heart cycle lengths in AF. Methods: Echocardiograms from 204 patients with AF during examination were analyzed offline. Patients with known heart failure (HF) were excluded. Peak global longitudinal strain (GLS) was averaged from 18 myocardial segments. To adjust for the varying heart cycle lengths, we indexed GLS with the square root of the RR-interval, (GLS/√(RR)). The composite endpoint included incident HF, stroke, myocardial infarction and all-cause mortality. Results: During a median follow-up of 2.4 years, 82 patients (40%) reached the composite endpoint. Decreasing GLS/√(RR) was significantly associated with the composite endpoint, and the risk of reaching the endpoint increased significantly per 1%/sec 1/2 decrease in strain (HR 1.13, 95% CI 1.07–1.20, p < 0.001). GLS/√(RR) remained an independent predictor even after adjustment for various risk factors and conventional echocardiography (LVEF and E/e′) (HR 1.10, 95% CI: 1.02–1.19, p = 0.017). In contrast, GLS did not remain a significant predictor after adjusting for the same variables (p = 0.07), neither did LVEF (p = 0.11). Conclusion: Decreasing GLS/√(RR) was significantly associated with increased risk of an adverse outcome and remained an independent predictor after multivariable adjustment. Indexing GLS with the square root of the RR-interval can counteract the variable cycle length in AF patients and GLS/√(RR) offers a more convincing risk-stratification assessment in AF patients compared with GLS. Highlights: Indexing strain with the RR-interval counteracts the variable cycle length in AF. Corrected GLS is an independent predictor of outcome in AF. Neither LVEF nor GLS remained as independent predictors of outcome. Corrected GLS may be a more accurate measure to assess cardiac function in AF. GLS/√(RR) is feasible, angle independent and easy to apply in a clinical setting.