Left ventricular hypertrophy and impaired global longitudinal strain as predictors of repeat emergency department visits for dyspnea

Abstract Background Left ventricular hypertrophy (LVH) and impaired myocardial mechanics, as quantified by reduced global longitudinal strain (GLS), have been implicated in the development of subclinical cardiac dysfunction. Patients presenting to the emergency department (ED) with dyspnea often experience recurrent symptoms that lead to repeat ED visits for dyspnea, yet the echocardiographic predictors of these repeat visits remain incompletely characterized. This study aimed to evaluate whether LVH and reduced GLS independently predict repeat ED visits for dyspnea in patients undergoing echocardiographic assessment. Methods In this retrospective cohort study, we reviewed the records of 1,339 adult patients who underwent comprehensive transthoracic echocardiography—including speckle-tracking analysis for GLS—after an initial presentation to the ED with dyspnea between January 2014 and December 2018. LVH was defined as left ventricular mass index >115 g/m² in men or >95 g/m² in women. Reduced GLS was defined as an absolute GLS value < –18%. The primary endpoint was a repeat ED visit for dyspnea after the index echocardiogram. We tracked ED revisit events through follow-up until June 30, 2022. Patients with primary respiratory causes of dyspnea (e.g., COPD exacerbation, pneumonia) were excluded. Results Among the 1,339 patients (mean age 64 ± 17 years; 53.5% male), 509 (38%) exhibited LVH and 589 (44%) demonstrated reduced GLS. During the follow-up period, 93 patients (6.9%) experienced at least one ED revisit for dyspnea. On univariate analysis, both LVH (hazard ratio [HR] 1.79; 95% confidence interval [CI] 1.25–2.86; p = 0.02) and reduced GLS (HR 1.67; 95% CI 1.21–2.46; p = 0.002) were associated with increased risk of repeat ER visits. In multivariable Cox regression, LVH (adjusted HR 1.59; 95% CI 1.16–2.63; p = 0.04) and reduced GLS (adjusted HR 1.62; 95% CI 1.09–2.40; p = 0.017) remained independent predictors of repeat ER visits for dyspnea, after controlling for age, sex, hypertension, diabetes, and left ventricular ejection fraction. Conclusions In patients evaluated for dyspnea, the presence of LVH and reduced GLS on echocardiography were both independently associated with a higher likelihood of repeat ER visit for dyspnea within one year. Incorporating assessment of LVH and GLS into routine echocardiographic evaluation may improve risk stratification and identify individuals who might benefit from closer outpatient monitoring or earlier initiation of targeted therapies aimed at preventing recurrent dyspneic episodes.