Podcast- Dr. John W. Ostrominski, MD- Cost and Value in Contemporary Heart Failure Clinical Guidance Documents @Brigh...

Dr. John W. Ostrominski is an internist at Brigham and Women's Hospital and Massachusetts General Hospital in Boston, Massachusetts. In this podcast Dr. Ostrominski discusses Cost and Value in Contemporary Heart Failure Clinical Guidance Documents.

Link to Abstract-
https://www.jacc.org/doi/10.1016/j.jchf.2021.08.002

Abstract -
The researchers wanted to see if global longitudinal strain (GLS) is linked to the natural history of patients with heart failure (HF) who had a better ejection fraction (HFimpEF).

Background

The ejection fraction (EF) of the left ventricle (LV) generally improves in people who have a low EF. Patients with HFimpEF, on the other hand, have a wide range of clinical outcomes. GLS, a sensitive biomarker of LV systolic function, could help this population estimate the risk of future occurrences.

Methods

Retrospective examination of HF patients with LVEF greater than 40% on index echocardiography who had LVEF less than 40% on initial study and improved by 10%. On index echocardiography, GLS was measured using 2-dimensional speckle-tracking software. The primary outcome was the time it took for cardiovascular death or HF hospitalization/emergency treatment to occur for the first time.

Results

The median absolute values of GLS (aGLS) and LVEF from index echocardiogram were 12.7 percent (IQR: 10.8 percent-14.7 percent) and 52 percent (IQR: 46 percent -58 percent) for the 289 patients with HFimpEF, respectively. The primary endpoint occurred less frequently in patients with aGLS above the median than below it (21 percent vs 34 percent; P = 0.014); HR of 0.51; 95 percent CI: 0.33-0.81; P = 0.004; HR of 0.51; 95 percent CI: 0.33-0.81; P = 0.004; HR of 0.51; 95 percent CI: 0.33-0.81; P = 0.004; HR of 0.51; 95 percent CI: 0.3 When aGLS on index echocardiogram was assessed as a continuous variable, each 1% increase was associated with a lower likelihood of the composite endpoint; HR 0.86; 95 percent CI: 0.79-0.93; P 0.001, an association that persisted after multivariable adjustment; HR 0.90; 95 percent CI: 0.82-0.97; P = 0.01. Lower aGLS was linked to a higher chance of LVEF worsening.

Conclusions

GLS is a powerful predictor of future HF episodes and heart function impairment in patients with HFimpEF.