Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.
ESC Heart Fail. 2021 Oct;8(5):4343-4345. doi: 10.1002/ehf2.13465. Epub 2021 Jul 17.
Global longitudinal strain (GLS) has become an alternative to left ventricular ejection fraction (LVEF) to determine systolic function of the heart. The absence of cut-off values is one of the limitations preventing full clinical implementation. The aim of this study is to determine a cut-off value of GLS for an increased risk of adverse events in individuals with a normal LVEF.
Echocardiographic images of 502 subjects (52% female, mean age 48 ± 15) with an LVEF ≥ 55% were analysed using speckle tracking-based GLS. The primary endpoint was cardiovascular death or cardiac hospitalization. The analysis of Cox models with splines was performed to visualize the effect of GLS on outcome. A cut-off value was suggested by determining the optimal specificity and sensitivity. The median GLS was -22.2% (inter-quartile range -20.0 to -24.9%). In total, 35 subjects (7%) had a cardiac hospitalization and/or died because of cardiovascular disease during a follow-up of 40 (5-80) months. There was a linear correlation between the risk for adverse events and GLS value. Subjects with a normal LVEF and a GLS between -22.9% and -20.9% had a mildly increased risk (hazard ratio 1.01-2.0) for cardiac hospitalization or cardiovascular mortality, and the risk was doubled for subjects with a GLS of -20.9% and higher. The optimal specificity and sensitivity were determined at a GLS value of -20.0% (hazard ratio 2.49; 95% confidence interval: 1.71-3.61).
There is a strong correlation between cardiac adverse events and GLS values in subjects with a normal LVEF. In our single-centre study, -20.0% was determined as a cut-off value to identify subjects at risk. A next step should be to integrate GLS values in a multi-parametric model.
全球纵向应变（GLS）已成为替代左心室射血分数（LVEF）来确定心脏收缩功能的一种方法。缺乏截断值是限制其全面临床应用的原因之一。本研究旨在确定 LVEF 正常个体中 GLS 的截断值，以识别发生不良心脏事件的高危人群。
对 502 名 LVEF≥55%的受试者的超声心动图图像进行分析，使用斑点追踪技术测量 GLS。主要终点为心血管死亡或心脏住院。使用样条 Cox 模型进行分析，以直观显示 GLS 对结果的影响。通过确定最佳的特异性和敏感性来建议截断值。中位 GLS 为-22.2%（四分位距-20.0 至-24.9%）。共有 35 名受试者（7%）在 40（5-80）个月的随访期间因心血管疾病住院或死亡。不良事件风险与 GLS 值之间存在线性相关性。LVEF 正常且 GLS 值在-22.9%和-20.9%之间的受试者，心脏住院或心血管死亡率的风险轻度增加（危险比 1.01-2.0），而 GLS 值为-20.9%及以上的受试者，风险增加一倍。特异性和敏感性最佳的截断值为 GLS 值-20.0%（危险比 2.49；95%置信区间：1.71-3.61）。
在 LVEF 正常的受试者中，心脏不良事件与 GLS 值之间存在很强的相关性。在我们的单中心研究中，确定-20.0%为截断值以识别高危人群。下一步应该是将 GLS 值纳入多参数模型。
