Author + information
- Cesare Russo,
- Zhezhen Jin,
- Shunichi Homma,
- Clinton B. Wright,
- Tatjana Rundek,
- Mitsuhiro Yoshita,
- Charles DeCarli,
- Mitchell SV Elkind,
- Ralph L. Sacco and
- Marco R. Di Tullio
Stroke prevention is a public health priority. Population studies have documented the presence of silent brain infarcts (SBI) in 10% to 20% of subjects without prior stroke. SBI are associated with a significant risk of future clinical stroke, cognitive impairment and dementia. Global longitudinal strain (GLS) is a measure of left ventricular (LV) systolic function that has prognostic value additive to that of LV ejection fraction (LVEF). GLS analysis has proved useful in unmasking subclinical abnormalities in cardiac function, even when LVEF is still in the normal range, in a variety of conditions which are also potent risk factors for stroke, such as hypertension and diabetes. It is not known if GLS can provide information on the presence of subclinical brain disease.
LVEF and GLS were assessed by two-dimensional and speckle-tracking echocardiography in stroke-free participants from the community-based Cardiovascular Abnormalities and Brain Lesions study. Presence of SBI was assessed by brain magnetic resonance imaging. Participants with LVEF<55%, atrial fibrillation and significant valvular disease were excluded from the analysis.
Mean age of the study sample (n=425) was 69.2±9.6 years, 62.1% were women, LV ejection fraction was 64.3±4.7%, GLS was −17.2±2.9%. In this sample with normal LVEF, hypertension was present in 72.5%, diabetes in 26.8%, history of coronary artery disease in 4.5%. SBI were detected in 51 (12.0%) participants. GLS was significantly reduced in participants with SBI compared to those without (−15.9±3.1% vs. −17.4±2.8%, p<0.01), whereas LVEF showed no difference between the groups (65.0±4.8% vs. 64.2±4.7% respectively, p=0.24). In multivariate analysis adjusted for age, sex, hypertension, SBP, diabetes, LV mass and left atrial size, GLS remained a significant predictor of SBI (odds ratio/unit decrease=1.15, 95% CI 1.02-1.29, p<0.01), whereas LVEF was not (odds ratio/unit decrease =1.04, 95% CI 0.97-1.10, p=0.26).
A reduced GLS is independently associated with silent brain infarcts in a stroke-free community-based cohort with normal LVEF. GLS can provide additional information on stroke risk beyond LVEF assessment.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: Echo IX
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1227-343
- 2013 American College of Cardiology Foundation