Postsystolic Shortening by Speckle Tracking Echocardiography Is an Independent Predictor of Cardiovascular Events and Mortality in the General Population

BACKGROUND: Postsystolic shortening (PSS) has been proposed as a novel marker of contractile dysfunction in the myocardium. Our objective was to assess the prognostic potential of PSS on cardiovascular events and death in the general population.

METHODS AND RESULTS: The study design consisted of a prospective cohort study of 1296 low-risk participants from the general population, who were examined by speckle tracking echocardiography. The primary end point was the composite of heart failure, myocardial infarction, and cardiovascular death, defined as major adverse cardiovascular events (MACEs). The secondary end point was all-cause death. The postsystolic index (PSI) was defined as follows: [(maximum strain in cardiac cycle-peak systolic strain)/(maximum strain in cardiac cycle)]×100. PSS was regarded as present if PSI >20%. During a median follow-up of 11 years, 149 participants (12%) were diagnosed as having MACEs and 236 participants (18%) died. Increasing number of walls with PSS predicted both end points, an association that persisted after adjustment for age, sex, estimated glomerular filtration rate, global longitudinal strain, hypertension, heart rate, left ventricular ejection fraction, LV mass index, pro-B-type natriuretic peptide, previous ischemic heart disease, systolic blood pressure, average peak early diastolic longitudinal mitral annular velocity (e'), ratio between peak transmitral early and late diastolic inflow velocity (E/A), and left atrial volume index: MACEs (hazard ratio, 1.35; 95% confidence interval, 1.09-1.67;P=0.006 per 1 increase in walls displaying PSS) and death (hazard ratio, 1.30; 95% confidence interval, 1.08-1.57;P=0.006 per 1 increase in walls displaying PSS). The strongest predictor of end points was ≥2 walls exhibiting PSS. The PSI also predicted increased risk of the end points, and the associations remained significant in multivariable models: MACEs (per 1% increase in PSI: hazard ratio, 1.18; 95% confidence interval, 1.02-1.36;P=0.024) and death (per 1% increase in PSI: hazard ratio, 1.18; 95% confidence interval, 1.05-1.33;P=0.005).

CONCLUSIONS: Presence of PSS in the general population provides independent and long-term prognostic information on the occurrence of MACEs and death.