Early systolic lengthening by speckle tracking echocardiography predicts outcome after coronary artery bypass surgery. (June 2021)

• Record Type: Journal Article
• Authors: Brainin, Philip; Lindberg, Søren; Olsen, Flemming J.; Pedersen, Sune; Iversen, Allan; Galatius, Søren; Fritz-Hansen, Thomas; Gislason, Gunnar; Søgaard, Peter; Møgelvang, Rasmus; Biering-Sørensen, Tor
• Is Part Of: IJC heart & vasculature. Volume 34(2021)
• Publication Date: 2021-06
• Subjects: Systolic lengthening -- Deformation -- Revascularization -- Prognosis; A late transmitral inflow velocity -- CABG coronary artery bypass graft -- CK-MB creatine kinase myocardial band -- E early transmitral inflow velocity -- e' early diastolic tissue velocity -- ESL early systolic lengthening -- GLS global longitudinal strain -- HR hazard ratio -- IDI integrated discrimination improvement -- IQR interquartile range -- LV left ventricular -- LVEF left ventricular ejection fraction -- NRI net reclassification index; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2021.100799
• Languages: English
• ISSNs: 2352-9067

Abstract

Highlights: Early systolic lengthening (ESL) is a paradoxical lengthening of myocardial fibers. Speckle tracking echocardiography is a common imaging tool for assessment of ESL. ESL was a predictor of cardiovascular and all-cause death in CABG patients. Specifically, the prognostic value of ESL was enhanced in women undergoing CABG. Abstract: Background: Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to loss of myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients. Methods: We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox models adjusted for clinical risk assessed as EuroSCORE II. Results: During median follow-up of 3.8 years [IQR 2.7–4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, each 1% increase in amplitude of ESL was associated with CVD (HR 1.35 [95%CI 1.09–1.68], P = 0.006) and all-cause mortality (HR 1.29 [95%CI 1.08–1.54], P = 0.004). Similar findings applied to duration of ESL (per 10ms increase) and CVD (HR 1.12 [95%CI 1.02–1.23], P = 0.016) and all-cause mortality (HR 1.09 [95%CI 1.01––1.17], P = 0.031). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that the prognostic value was greater in women for both endpoints. When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality. Conclusions: Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients.