ISSN 2149-2263 | E-ISSN 2149-2271
Volume : 25 Issue : 12 Year : 2021
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The Anatolian Journal of Cardiology Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality [Anatol J Cardiol]
Anatol J Cardiol. 2021; 25(12): 863-871 | DOI: 10.5152/AnatolJCardiol.2021.21940

Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality

Pelin Karaca Özer1, Elif Ayduk Gövdeli1, Berat Engin2, Adem Atıcı3, Derya Baykız1, Hüseyin Orta1, Zeynep Gizem Demirtakan1, Samim Emet1, Ali Elitok4, Yelda Tayyareci4, Berrin Umman1, Ahmet Kaya Bilge1, Zehra Buğra1
1Department of Cardiology, İstanbul Medical Faculty, İstanbul University; İstanbul-Turkey
2Department of Cardiology, Manavgat State Hospital; Antalya-Turkey
3Department of Cardiology, İstanbul Medeniyet University, Göztepe Training and Research Hospital; İstanbul-Turkey
4Department of Cardiology, İstinye University, Liv Hospital; İstanbul-Turkey

Objective: In this study, we aimed to compare the functional adaptations of the left ventricle in variant forms of left ventricular hypertrophy (LVH) and to evaluate the use of two-dimensional speckle tracking echocardiography (2D-STE) in differential diagnosis and prognosis.
Methods: This was a prospective cohort study of 68 patients with LVH, including 20 patients with non-obstructive hypertrophic cardiomyopathy (HCM), 23 competitive top-level athletes free of cardiovascular disease, and 25 patients with hypertensive heart disease (HHD). All the subjects underwent 2D transthoracic echocardiography (TTE) and 2D-STE. The primary endpoint was all-cause mortality. Global longitudinal strain (GLS) below −12.5% was defined as severely reduced strain, −12.5% to −17.9% as mildly reduced strain, and above −18% as normal strain.
Results: The mean LV-GLS value was higher in athletes than in patients with HCM and HHD with the lowest value being in the HCM group (HCM: −11.4±2.2%; HHD: −13.6±2.6%; and athletes: −15.5±2.1%; p<0.001 among groups). LV-GLS below −12.5% distinguished HCM from others with 65% sensitivity and 77% specificity [area under curve (AUC)=0.808, 95% confidence interval (CI): 0.699–0.917, p<0.001]. The median follow-up duration was 6.4±1.1 years. Overall, 11 patients (16%) died. Seven of these were in the HHD group, and four were in the HCM group. The mean GLS value in patients who died was −11.8±1.5%. LV-GLS was significantly associated with mortality after adjusting age and sex via multiple analysis (RR=0.723, 95% CI: 0.537–0.974, p=0.033). Patients with GLS below −12.5% had a higher risk of all-cause mortality compared with that of patients with GLS above −12.5% according to Kaplan-Meier survival analysis for 7 years (29% vs. 9%; p=0.032). The LV-GLS value predicts mortality with 64% sensitivity and 70% specificity with a cut-off value of −12.5 (AUC=0.740, 95% CI: 0.617-0.863, p=0.012).
Conclusion: The 2D-STE provides important information about the longitudinal systolic function of the myocardium. It may enable differentiation variable forms of LVH and predict prognosis.

Keywords: left ventricular hypertrophy, hypertension, hypertrophic cardiomyopathy, athlete’s heart, speckle-tracking echocardiography

Pelin Karaca Özer, Elif Ayduk Gövdeli, Berat Engin, Adem Atıcı, Derya Baykız, Hüseyin Orta, Zeynep Gizem Demirtakan, Samim Emet, Ali Elitok, Yelda Tayyareci, Berrin Umman, Ahmet Kaya Bilge, Zehra Buğra. Role of global longitudinal strain in discriminating variant forms of left ventricular hypertrophy and predicting mortality. Anatol J Cardiol. 2021; 25(12): 863-871

Corresponding Author: Pelin Karaca Özer, Türkiye
Manuscript Language: English