TY - JOUR

T1 - Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population

T2 - The Copenhagen City Heart Study

AU - Biering-Sørensen, Tor

AU - Biering-Sørensen, Sofie Reumert

AU - Olsen, Flemming Javier

AU - Sengeløv, Morten

AU - Jørgensen, Peter Godsk

AU - Mogelvang, Rasmus

AU - Shah, Amil M

AU - Jensen, Jan Skov

N1 - © 2017 American Heart Association, Inc.

PY - 2017/3

Y1 - 2017/3

N2 - BACKGROUND: Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown.METHODS AND RESULTS: A total of 1296 participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death. During a median follow-up of 11 years, 149 (12%) participants were diagnosed with heart failure, acute myocardial infarction, or cardiovascular death. Lower GLS was associated with a higher risk of the composite end point (hazard ratio, 1.12; 95% confidence interval, 1.08-1.17; P<0.001 per 1% decrease), an association that persisted after multivariable adjustment for age, sex, heart rate, hypertension, systolic blood pressure, left ventricular ejection fraction, left ventricular mass index, left ventricular dimension, deceleration time, left atrium dimension, E/e', and pro B-type natriuretic peptide (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11; P=0.045 per 1% decrease). GLS provided incremental prognostic information beyond the Framingham Risk Score, the Systemic Coronary Evaluation risk chart, and the modified American College of Cardiology/American Heart Association Pooled Cohort Equation for the composite outcome and incident heart failure. Sex modified the relationship between GLS and outcome such that after multivariable adjustment, GLS was an independent predictor of outcomes in men but not in women (hazard ratio, 1.14; 95% confidence interval, 1.06-1.24; P=0.001, and hazard ratio, 0.99; 95% confidence interval, 0.92-1.07; P=0.81, respectively; P for interaction =0.032).CONCLUSIONS: In the general population, GLS provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality. GLS seems to be a stronger prognosticator in men than in women.

AB - BACKGROUND: Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown.METHODS AND RESULTS: A total of 1296 participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death. During a median follow-up of 11 years, 149 (12%) participants were diagnosed with heart failure, acute myocardial infarction, or cardiovascular death. Lower GLS was associated with a higher risk of the composite end point (hazard ratio, 1.12; 95% confidence interval, 1.08-1.17; P<0.001 per 1% decrease), an association that persisted after multivariable adjustment for age, sex, heart rate, hypertension, systolic blood pressure, left ventricular ejection fraction, left ventricular mass index, left ventricular dimension, deceleration time, left atrium dimension, E/e', and pro B-type natriuretic peptide (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11; P=0.045 per 1% decrease). GLS provided incremental prognostic information beyond the Framingham Risk Score, the Systemic Coronary Evaluation risk chart, and the modified American College of Cardiology/American Heart Association Pooled Cohort Equation for the composite outcome and incident heart failure. Sex modified the relationship between GLS and outcome such that after multivariable adjustment, GLS was an independent predictor of outcomes in men but not in women (hazard ratio, 1.14; 95% confidence interval, 1.06-1.24; P=0.001, and hazard ratio, 0.99; 95% confidence interval, 0.92-1.07; P=0.81, respectively; P for interaction =0.032).CONCLUSIONS: In the general population, GLS provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality. GLS seems to be a stronger prognosticator in men than in women.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Biomechanical Phenomena

KW - Cardiovascular Diseases/diagnostic imaging

KW - Cause of Death

KW - Chi-Square Distribution

KW - Denmark/epidemiology

KW - Echocardiography, Doppler, Color

KW - Female

KW - Heart Failure/mortality

KW - Humans

KW - Incidence

KW - Kaplan-Meier Estimate

KW - Longitudinal Studies

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Contraction

KW - Myocardial Infarction/mortality

KW - Predictive Value of Tests

KW - Prognosis

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Sex Factors

KW - Stress, Mechanical

KW - Stroke Volume

KW - Time Factors

KW - Ventricular Function, Left

KW - Young Adult

U2 - 10.1161/CIRCIMAGING.116.005521

DO - 10.1161/CIRCIMAGING.116.005521

M3 - Journal article

C2 - 28264868

VL - 10

JO - Circulation: Cardiovascular Imaging

JF - Circulation: Cardiovascular Imaging

SN - 1941-9651

IS - 3

M1 - e005521

ER -