Background
Methods
Transthoracic echocardiography and global longitudinal strain
Adequacy of measurements
Outcome
Statistical analysis
Results
Population characteristics
Characteristic | Whole population | LV GLS |
P Value
| |||
---|---|---|---|---|---|---|
< −14.15 | –14.5 to −10.55 | –10.54 to −6.41 | > −6.41 | |||
Age (years) | 63.8 ± 15 | 66.3 ± 14 | 63.4 ± 15.8 | 65.7 ± 13.9 | 59.7 ± 16.3 | 0.116 |
Male | 87 (42.4%) | 11 (21.6%) | 19 (37.3%) | 25 (48.1%) | 32 (62.7%) | <0.001 |
Sodium level | 138.3 ± 3.4 | 138.1 ± 4.2 | 139 ± 3 | 138.7 ± 3.4 | 137.5 ± 2.9 | 0.153 |
Creatinine | 2.2 ± 2.4 | 2.6 ± 3.6 | 2.6 ± 2.5 | 1.7 ± 1.2 | 1.8 ± 1.5 | 0.163 |
LVEF | 40.4 ± 17.4 | 60.4 ± 7.5 | 47.8 ± 11.6 | 30.9 ± 10.4 | 22.3 ± 5.9 | <0.001 |
Medication use | ||||||
ACEI or ARBs | 140 (69.7%) | 25 (49%) | 32 (65.3%) | 39 (78%) | 44 (86.3%) | <0.001 |
β-Blocker | 173 (86.1%) | 37 (72.5%) | 43 (87.8%) | 47 (94%) | 46 (90.2%) | 0.011 |
Hydralazine | 55 (27.5% | 14 (27.5%) | 21 (43.8%) | 9 (18%) | 11 (21.6%) | 0.023 |
Ca channel Blockers | 45 (22.6%) | 17 (33.3%) | 19 (39.6%) | 6 (12%) | 3 (6%) | <0.001 |
Loop diuretics | 164 (81.6%) | 41 (80.4%) | 37 (75.5%) | 41 (82%) | 45 (88.2%) | 0.43 |
Aldosterone-antagonists | 19 (9.7%) | 1 (2%) | 3 (6.3%) | 5 (10.4%) | 10 (19.6%) | 0.021 |
NYHA functional class | ||||||
Class I | 55 (28.8%) | 17 (36.2%) | 16 (34%) | 14 (28.6%) | 8 (16.7%) | |
Class II | 78 (40.8%) | 19 (40.4%) | 15 (31.9%) | 24 (49%) | 20 (41.7%) | 0.087 |
Class III | 55 (28.8%) | 9 (19.1%) | 16 (34%) | 10 (20.4%) | 20 (41.7%) | |
Class IV | 3 (1.6%) | 2 (4.3%) | 0 | 1 (2%) | 0 | |
Blood pressure (mmHg) | ||||||
Systolic | 148.7 ± 38.4 | 158.5 ± 35.9 | 166.5 ± 38 | 145.2 ± 36.6 | 124.7 ± 29.7 | <0.001 |
Diastolic | 84.9 ± 21.6 | 83.1 ± 23.5 | 89.1 ± 22.2 | 86.1 ± 21.9 | 81.3 ± 18.2 | 0.28 |
Heart rate (bpm) | 86.1 ± 21.5 | 79.2 ± 19.1 | 86 ± 20.3 | 87.7 ± 22.2 | 91.6 ± 23.1 | 0.032 |
History of ischemic heart disease | 80 (39%) | 13 (25.5%) | 23 (45.1%) | 27 (51.9%) | 17 (33.3%) | 0.029 |
Chronic obstructive pulmonary disease | 30 (14.6%) | 6 (11.8%) | 10 (19.6%) | 6 (11.5%) | 8 (15.7%) | 0.617 |
Diabetes | 79 (38.5%) | 15 (29.4%) | 23 (45.1%) | 24 (46.2%) | 17 (33.3%) | 0.206 |
Hypertension | 190 (93.1%) | 46 (90.2%) | 50 (98%) | 49 (94.2%) | 45 (90%) | 0.324 |
Readmission
HF Readmission | |||
---|---|---|---|
Variable | Hazard ratio | 95% CI |
p-value |
LV GLS –14.15 to –10.55 | 3.144 | 1.46–6.74 | 0.003 |
LV GLS –10.54 to 6.41 | 7.40 | 3.55–15.39 | <0.001 |
LV GLS > −6.41 | 7.87 | 3.79–16.34 | <0.001 |
LV GLS as a continuous variable a
| 1.17 | 1.12–1.23 | <0.001 |
LVEF | 0.97 | 0.96–0.98 | <0.001 |
Age | 1.01 | 0.99–1.02 | 0.099 |
Male | 1.11 | 0.77–1.61 | 0.566 |
NYHA functional class II | 1.3 | 0.77–2.19 | 0.314 |
NYHA functional class III | 2.01 | 1.18–3.41 | 0.01 |
NYHA functional class IV | 0.92 | 0.12–6.87 | 0.937 |
Systolic blood pressure | 0.98 | 0.98–0.99 | <0.001 |
Diastolic blood pressure | 0.99 | 0.98–0.99 | 0.025 |
Heart rate | 1 | 0.99–1.01 | 0.137 |
Creatinine | 0.9 | 0.82–1 | 0.052 |
Sodium level | 0.93 | 0.88–0.98 | 0.018 |
History of ischemic heart disease | 1.55 | 1.07–2.24 | 0.021 |
Diabetes | 1 | 0.68–1.46 | 0.983 |
Hypertension | 1.45 | 0.59–3.55 | 0.418 |
Dementia | 12.18 | 1.54–95.95 | 0.018 |
Chronic obstructive pulmonary disease | 1.24 | 0.76–2.01 | 0.382 |
ACEI-ARBs | 1.83 | 1.17–2.86 | 0.008 |
Variable | Number/Mean/Percentage | Hazard Ratio | 95% Confidence Interval |
p-value |
---|---|---|---|---|
LV GLS Quartile 2 (−14.15 to −10.55) |
N = 51 | 3.16 | 1.26–7.90 | 0.014 |
LV GLS Quartile 3 (−10.54 to −6.41) |
N = 52 | 5.19 | 1.70–15.82 | 0.004 |
LV GLS Quartile 4 (> − 6.41) |
N = 51 | 5.30 | 1.43–19.60 | 0.012 |
LV GLS as a continuous variablea
| −10.6 ± 4.7% | 1.23 | 1.09–1.40 | 0.001 |
Age | 63.8 ± 15 | 1.02 | 1.002–1.03 | 0.027 |
Left ventricular ejection fraction | 40 ± 17% | 0.98 | 0.95–1.02 | 0.288 |
History of ischemic heart disease | 39% | 1.13 | 0.71–1.78 | 0.608 |
NYHA III | 29% | 1.79 | 0.98–3.29 | 0.060 |
Use of ACEI/ARBs | 70% | 0.96 | 0.565–1.65 | 0.894 |
Systolic blood pressure | 149 ± 38 | 0.999 | 0.99–1.01 | 0.689 |
Sodium level | 138 ± 3 | 0.94 | 0.88–1.00 | 0.53 |