Global longitudinal strain and mechanical dispersion predict cardiovascular events in a middle-aged population: the ACE1950 study
C Koch, M N Lyngbakken, E N Aagaard, T Berge, A Tveit, T Omland, K Steine, H Rosjo, B KvisvikAbstract
Background
Global longitudinal strain (GLS) reflects subclinical left ventricular dysfunction and has been linked to adverse outcomes in selected populations. Mechanical dispersion (MD), reflecting mechanical heterogeneity, adds prognostic value in cardiac disease, but its prognostic relevance in the general population remains uncertain.
Purpose
To investigate associations of GLS and MD with incident major adverse cardiovascular events (MACE) and all-cause mortality in a population-based cohort.
Methods
The ACE1950 Study enrolled 3,706 individuals born in 1950 between 2013 and 2015. Among these, 2,495 participants with complete strain and covariate data were analyzed. GLS and MD were assessed by speckle-tracking echocardiography. Participants were followed until December 31 st , 2022, for incident MACE (myocardial infarction, stroke, heart failure, or coronary revascularization) and all-cause mortality. Multivariable Cox regression models adjusted for cardiovascular risk factors and left ventricular ejection fraction were applied. Non-linearity of GLS was assessed using restricted cubic splines.
Results
Over a median follow-up of 8.3 years, 180 MACE and 118 deaths occurred. GLS demonstrated a non-linear association with MACE, with increased risk confined to lower strain values. MD was independently associated with MACE (HR 1.16 per SD increase, 95% CI 1.01–1.33; p=0.034) and improved model fit beyond risk factors, ejection fraction, and GLS (likelihood-ratio p=0.016). Associations were weaker after adjustment for prevalent coronary artery disease. Neither GLS nor MD were associated with all-cause mortality.
Conclusion
In this middle-aged general population, lower GLS values were associated with incident cardiovascular events. MD provided incremental prognostic information beyond conventional risk markers and ejection fraction.Association between GLS and MACE