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Left ventricular global longitudinal strain predicts major adverse cardiac events and all-cause mortality in heart transplant patients

Affiliations

  • 1 Departments of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: [email protected]
  • 2 Departments of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  • 3 Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
  • PMID: 28089194
  • DOI: 10.1016/j.healun.2016.12.002

Left ventricular global longitudinal strain predicts major adverse cardiac events and all-cause mortality in heart transplant patients

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Authors

Affiliations

  • 1 Departments of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: [email protected]
  • 2 Departments of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  • 3 Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
  • PMID: 28089194
  • DOI: 10.1016/j.healun.2016.12.002

Abstract

Background: Left ventricular global longitudinal strain (LVGLS) is a robust longitudinal myocardial deformation marker that is strongly affected by cardiac allograft vasculopathy (CAV), microvascular dysfunction, and acute cellular rejection (ACR). We evaluated graft deformation for risk stratification in long-term heart transplant (HTx) patients.

Methods: The study included 196 patients who underwent HTx between 2011 and 2013. Patients underwent comprehensive echocardiography and coronary angiography. Previous rejection burden was assessed, and ACR grades were calculated. Patients were prospectively followed until February 24, 2016. Major adverse cardiac events (MACE), including coronary event, heart failure, treated rejection, and cardiovascular death, and all-cause mortality were recorded.

Results: During follow-up, 57 patients experienced MACE. Median follow-up was 1,035 (interquartile range [IQR] 856-1,124) days. Median time to first event was 534 (IQR 276-763) days. LVGLS was a strong predictor of MACE (hazard ratio [HR] 4.9, 95% confidence interval [CI] 2.7-8.9, p Conclusions: Measurement of LVGLS strongly predicts MACE and mortality in long-term HTx patients. Predictive ability was seen in patients with and without CAV. A combined model of left ventricular systolic deformation by LVGLS and diastolic graft performance by LVFP was a stronger model for prediction of MACE and all-cause mortality.

Keywords: cardiac allograft vasculopathy; global longitudinal systolic function; heart transplantation; prognosis; time-to-event analysis.

Copyright © 2017 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Measurement of LVGLS strongly predicts MACE and mortality in long-term HTx patients. Predictive ability was seen in patients with and without CAV. A combined model of left ventricular systolic deformation by LVGLS and diastolic graft performance by LVFP was a stronger model for prediction of MACE an …