Page 23 - The role of advanced echocardiography in patients with ischemic heart disease - Rachid Abou

Nevertheless, LV GLS has shown to be an important prognostic parameter in the risk 1 stratification of patients after acute myocardial infarction as well as in those with
chronic coronary syndromes.25, 26 A previous study has shown that LV GLS was better
correlated with myocardial infarct size (as assessed by cardiac magnetic resonance)
than LVEF in 61 patients with myocardial infarction.27 Strain imaging has the potential to identify significant coronary stenosis in patients who present with stable angina, as well as non-ST-segment elevation myocardial infarction.28 Furthermore, the pattern of longitudinal strain values as provided by the polar-plot offers additional information on the affected coronary artery and the extent of myocardial damage.24 Recent work by Huttin et al,29 demonstrated an association between LV GLS and adverse remodelling (increased LV end-diastolic volume or LV-end systolic volume (>15% to 20%)) (pooled multivariable odds ratio [OR] = 1.38, 1.13-1.70, p=0.002), which is incremental to conventional echocardiographic parameters for predicting adverse LV remodelling. Furthermore, LV GLS has been demonstrated to predict recovery of LV systolic function post-infarct. In a study by Mollema et al,30 baseline LV GLS (-13,7%) yielded a sensitivity of 86% and a specificity of 74% to predict LV functional recovery at one year follow-up.
Valvular heart disease
Decisions on surgical and transcatheter intervention for valvular heart disease are mainly based on the severity of valve disease, while LVEF assumes a more prominent role in asymptomatic patients. Due to the load-dependent nature of LVEF, as well as a fraction of the LV volume which is pumped into the LA during systole, LVEF overestimates systolic function in the context of mitral regurgitation.31 LV GLS is less load-dependent than LVEF, and has proven to be a good predictor of post-operative LVEF in severe mitral regurgitation. LV GLS >-19.9% was an independent predictor of long-term LV systolic function after mitral valve repair in a study of 233 patients with moderate to severe primary mitral regurgitation.32
Aortic valve replacement is recommended in patients with asymptomatic, severe aortic stenosis and LVEF<50%. LVEF however, has limited sensitivity in the context of a hypertrophic LV. Impaired LV GLS has been correlated with LV fibrosis, and is associated with the development of symptoms and mortality in asymptomatic, severe aortic stenosis.33 Furthermore, LV GLS also predicts recovery of LV function after aortic valve replacement for aortic stenosis.34 Although, contemporary guidelines do not recommend routine use of LV GLS, the evidence showing that LV GLS is associated with prognosis in patients with severe aortic stenosis is growing.35 Current guidelines still advocate a conservative strategy in patients with asymptomatic severe aortic regurgitation, preserved LVEF and a non-dilated left ventricle. LV GLS may already be
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