Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis

Trine Kiilerich Lauridsen; Christina Alhede; Anna Lisa Crowley; Joseph Kisslo; Lars L. Sørensen; Thomas Fritz Hansen; Niels Risum; Carsten Toftager Larsen; Christian Hassager; Peter Søgaard; Anders Dahl; Niels Eske Bruun

doi:10.1016/j.ijcard.2018.01.031

Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis

Trine Kiilerich Lauridsen^*, Christina Alhede, Anna Lisa Crowley, Joseph Kisslo, Lars L. Sørensen, Thomas Fritz Hansen, Niels Risum, Carsten Toftager Larsen, Christian Hassager, Peter Søgaard, Anders Dahl, Niels Eske Bruun

^*Corresponding author for this work

Department of Clinical Medicine

5 Citations (Scopus)

Abstract

Background: Impaired cardiac function is the main predictor of poor outcome in infective endocarditis (IE). Global longitudinal strain (GLS) derived from two-dimensional strain echocardiography has proven superior in prediction of long-term outcome as compared to left ventricular ejection fraction (LVEF) in valvular disease and heart failure in general. Whether measurements of cardiac deformation can predict survival in patients with IE has not previously been investigated. Methods: The study included consecutive patients with Duke definite IE who underwent transthoracic and transesophageal echocardiography within 7 days. Clinical and echocardiographic markers associated with 1-year survival were identified using a Cox-proportional hazards model that included propensity adjustment for surgery. Reclassification statistics including receiver operating characteristic curves and net reclassification improvement were applied to LVEF and GLS, respectively. Results: A cohort of 190 patients met eligibility criteria. LVEF and GLS were both prognostic markers of mortality. Independent markers of 1-year mortality were S. aureus IE (HR:2.02; 95%CI 1.11–5.72, p =.022), diabetes (HR:2.05; 95%CI 1.12–3.75, p =.020), embolic stroke (HR:3.95; 95%CI 1.93–8.10, p <.001) and LVEF<45% (HR: 3.02; 95% CI 1.70–5.38, p <.001), GLS > −15.4% (HR:2.95; 95%CI 1.52–5.72, p <.001). Adding LVEF<45% to a model with known risk factors of IE did not significantly improve risk classification, whereas addition of GLS to the model resulted in significant increase (AUC = 0.763, p <.001). Conclusions: When treatment was taken into account, LVEF<45% and GLS > −15.4% were both associated with adverse long-term outcome in left-sided IE. GLS > −15.4 % was significantly associated with 1-year mortality in the multivariate analysis. Further, GLS was superior to LVEF in risk prediction and risk discrimination of long-term outcome in patients with left-sided IE.

Original language	English
Journal	International Journal of Cardiology
Volume	260
Pages (from-to)	118-123
Number of pages	6
ISSN	0167-5273
DOIs	https://doi.org/10.1016/j.ijcard.2018.01.031
Publication status	Published - 2018

Keywords

2D strain echocardiography
Infective endocarditis
LVEF

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ijcard.2018.01.031

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Lauridsen, T. K., Alhede, C., Crowley, A. L., Kisslo, J., Sørensen, L. L., Hansen, T. F., Risum, N., Larsen, C. T., Hassager, C., Søgaard, P., Dahl, A., & Bruun, N. E. (2018). Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis. International Journal of Cardiology, 260, 118-123. https://doi.org/10.1016/j.ijcard.2018.01.031

Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis. / Lauridsen, Trine Kiilerich; Alhede, Christina; Crowley, Anna Lisa et al.

In: International Journal of Cardiology, Vol. 260, 2018, p. 118-123.

Research output: Contribution to journal › Journal article › Research › peer-review

Lauridsen, TK, Alhede, C, Crowley, AL, Kisslo, J, Sørensen, LL, Hansen, TF, Risum, N, Larsen, CT, Hassager, C, Søgaard, P, Dahl, A & Bruun, NE 2018, 'Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis', International Journal of Cardiology, vol. 260, pp. 118-123. https://doi.org/10.1016/j.ijcard.2018.01.031

@article{0af92a03d4284ab1bef43f9cb8621dff,

title = "Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis",

abstract = "Background: Impaired cardiac function is the main predictor of poor outcome in infective endocarditis (IE). Global longitudinal strain (GLS) derived from two-dimensional strain echocardiography has proven superior in prediction of long-term outcome as compared to left ventricular ejection fraction (LVEF) in valvular disease and heart failure in general. Whether measurements of cardiac deformation can predict survival in patients with IE has not previously been investigated. Methods: The study included consecutive patients with Duke definite IE who underwent transthoracic and transesophageal echocardiography within 7 days. Clinical and echocardiographic markers associated with 1-year survival were identified using a Cox-proportional hazards model that included propensity adjustment for surgery. Reclassification statistics including receiver operating characteristic curves and net reclassification improvement were applied to LVEF and GLS, respectively. Results: A cohort of 190 patients met eligibility criteria. LVEF and GLS were both prognostic markers of mortality. Independent markers of 1-year mortality were S. aureus IE (HR:2.02; 95%CI 1.11–5.72, p =.022), diabetes (HR:2.05; 95%CI 1.12–3.75, p =.020), embolic stroke (HR:3.95; 95%CI 1.93–8.10, p <.001) and LVEF<45% (HR: 3.02; 95% CI 1.70–5.38, p <.001), GLS > −15.4% (HR:2.95; 95%CI 1.52–5.72, p <.001). Adding LVEF<45% to a model with known risk factors of IE did not significantly improve risk classification, whereas addition of GLS to the model resulted in significant increase (AUC = 0.763, p <.001). Conclusions: When treatment was taken into account, LVEF<45% and GLS > −15.4% were both associated with adverse long-term outcome in left-sided IE. GLS > −15.4 % was significantly associated with 1-year mortality in the multivariate analysis. Further, GLS was superior to LVEF in risk prediction and risk discrimination of long-term outcome in patients with left-sided IE.",

keywords = "2D strain echocardiography, Infective endocarditis, LVEF",

author = "Lauridsen, {Trine Kiilerich} and Christina Alhede and Crowley, {Anna Lisa} and Joseph Kisslo and S{\o}rensen, {Lars L.} and Hansen, {Thomas Fritz} and Niels Risum and Larsen, {Carsten Toftager} and Christian Hassager and Peter S{\o}gaard and Anders Dahl and Bruun, {Niels Eske}",

year = "2018",

doi = "10.1016/j.ijcard.2018.01.031",

language = "English",

volume = "260",

pages = "118--123",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis

AU - Lauridsen, Trine Kiilerich

AU - Alhede, Christina

AU - Crowley, Anna Lisa

AU - Kisslo, Joseph

AU - Sørensen, Lars L.

AU - Hansen, Thomas Fritz

AU - Risum, Niels

AU - Larsen, Carsten Toftager

AU - Hassager, Christian

AU - Søgaard, Peter

AU - Dahl, Anders

AU - Bruun, Niels Eske

PY - 2018

Y1 - 2018

N2 - Background: Impaired cardiac function is the main predictor of poor outcome in infective endocarditis (IE). Global longitudinal strain (GLS) derived from two-dimensional strain echocardiography has proven superior in prediction of long-term outcome as compared to left ventricular ejection fraction (LVEF) in valvular disease and heart failure in general. Whether measurements of cardiac deformation can predict survival in patients with IE has not previously been investigated. Methods: The study included consecutive patients with Duke definite IE who underwent transthoracic and transesophageal echocardiography within 7 days. Clinical and echocardiographic markers associated with 1-year survival were identified using a Cox-proportional hazards model that included propensity adjustment for surgery. Reclassification statistics including receiver operating characteristic curves and net reclassification improvement were applied to LVEF and GLS, respectively. Results: A cohort of 190 patients met eligibility criteria. LVEF and GLS were both prognostic markers of mortality. Independent markers of 1-year mortality were S. aureus IE (HR:2.02; 95%CI 1.11–5.72, p =.022), diabetes (HR:2.05; 95%CI 1.12–3.75, p =.020), embolic stroke (HR:3.95; 95%CI 1.93–8.10, p <.001) and LVEF<45% (HR: 3.02; 95% CI 1.70–5.38, p <.001), GLS > −15.4% (HR:2.95; 95%CI 1.52–5.72, p <.001). Adding LVEF<45% to a model with known risk factors of IE did not significantly improve risk classification, whereas addition of GLS to the model resulted in significant increase (AUC = 0.763, p <.001). Conclusions: When treatment was taken into account, LVEF<45% and GLS > −15.4% were both associated with adverse long-term outcome in left-sided IE. GLS > −15.4 % was significantly associated with 1-year mortality in the multivariate analysis. Further, GLS was superior to LVEF in risk prediction and risk discrimination of long-term outcome in patients with left-sided IE.

AB - Background: Impaired cardiac function is the main predictor of poor outcome in infective endocarditis (IE). Global longitudinal strain (GLS) derived from two-dimensional strain echocardiography has proven superior in prediction of long-term outcome as compared to left ventricular ejection fraction (LVEF) in valvular disease and heart failure in general. Whether measurements of cardiac deformation can predict survival in patients with IE has not previously been investigated. Methods: The study included consecutive patients with Duke definite IE who underwent transthoracic and transesophageal echocardiography within 7 days. Clinical and echocardiographic markers associated with 1-year survival were identified using a Cox-proportional hazards model that included propensity adjustment for surgery. Reclassification statistics including receiver operating characteristic curves and net reclassification improvement were applied to LVEF and GLS, respectively. Results: A cohort of 190 patients met eligibility criteria. LVEF and GLS were both prognostic markers of mortality. Independent markers of 1-year mortality were S. aureus IE (HR:2.02; 95%CI 1.11–5.72, p =.022), diabetes (HR:2.05; 95%CI 1.12–3.75, p =.020), embolic stroke (HR:3.95; 95%CI 1.93–8.10, p <.001) and LVEF<45% (HR: 3.02; 95% CI 1.70–5.38, p <.001), GLS > −15.4% (HR:2.95; 95%CI 1.52–5.72, p <.001). Adding LVEF<45% to a model with known risk factors of IE did not significantly improve risk classification, whereas addition of GLS to the model resulted in significant increase (AUC = 0.763, p <.001). Conclusions: When treatment was taken into account, LVEF<45% and GLS > −15.4% were both associated with adverse long-term outcome in left-sided IE. GLS > −15.4 % was significantly associated with 1-year mortality in the multivariate analysis. Further, GLS was superior to LVEF in risk prediction and risk discrimination of long-term outcome in patients with left-sided IE.

KW - 2D strain echocardiography

KW - Infective endocarditis

KW - LVEF

U2 - 10.1016/j.ijcard.2018.01.031

DO - 10.1016/j.ijcard.2018.01.031

M3 - Journal article

C2 - 29622424

AN - SCOPUS:85044750079

SN - 0167-5273

VL - 260

SP - 118

EP - 123

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Two-dimensional global longitudinal strain is superior to left ventricular ejection fraction in prediction of outcome in patients with left-sided infective endocarditis

Abstract

Keywords

UN SDGs

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