Author + information
- Received August 27, 2018
- Revision received December 13, 2018
- Accepted January 23, 2019
- Published online May 15, 2019.
- Monika Przewlocka-Kosmala, MD, PhDa,b,c,
- Thomas H. Marwick, MBBS, PhD, MPHb,c,
- Hilda Yang, PhDb,
- Leah Wright, BSc, PhDc,
- Kazuaki Negishi, MD, PhDb and
- Wojciech Kosmala, MD, PhDa,b,c,∗ ()
- aCardiology Department, Wroclaw Medical University, Wroclaw, Poland
- bMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- cBaker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- ↵∗Address for correspondence:
Prof. Wojciech Kosmala, Cardiology Department, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Objectives This study investigated the prognostic utility of left ventricular (LV) untwisting (UT) in the elderly patients at risk of heart failure (HF).
Background LV UT mechanics represent a unique combination of LV filling linking ventricular relaxation and suction. The value of this parameter in the prediction of outcomes in patients at risk of HF is unclear.
Methods A group of 465 asymptomatic subjects ≥65 years of age with ≥1 HF risk factor (hypertension, diabetes, obesity), recruited from the community, underwent clinical evaluation and echocardiography including measurement of LV apical and basal peak UT velocities. Cox regression analysis was used to identify predictors of new-onset HF and cardiovascular death after a mean follow-up of 18.2 ± 7.5 months.
Results A composite of both of the study endpoints occurred in 54 patients (11.6%). Adverse outcome was significantly associated with apical (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.96 to 0.99; p = 0.006) UT but not with basal (p = 0.18) UT. The prognostic value of apical UT was independent of and incremental to clinical data, as expressed by the ARIC (Atherosclerosis Risk In Communities) study risk score, left atrial volume index (LAVI), and LV global longitudinal strain (GLS). The addition of apical UT to the model including ARIC risk score, LAVI, and GLS was associated with a 41% improvement in reclassification (p = 0.006).
Conclusions Echocardiographic assessment of apical UT provides incremental value in predicting adverse outcome in asymptomatic patients with HF risk factors. The inclusion of apical UT to the diagnostic algorithm may improve the prognostication process in this population.
Supported by Tasmanian Community Fund, Hobart, Tasmania, Australia, and Siemens Healthcare Australia, Melbourne, Victoria, Australia. Dr. Marwick has received research support from GE Medical Systems. Dr. Yang is supported by Health Professional Scholarship 100307 from the National Heart Foundation of Australia, Canberra. Dr. Negishi is supported by an award from the Select Foundation, Hobart, Tasmania, Australia. None of these agencies had any role in design, analysis, or interpretation of this study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. James Thomas, MD, served as Guest Editor for this paper.
- Received August 27, 2018.
- Revision received December 13, 2018.
- Accepted January 23, 2019.
- 2019 American College of Cardiology Foundation
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