Background-Longitudinal myocardial deformation indexes appear superior to left ventricular ejection fraction (LVEF) in assessing myocardial contractility. However, few studies have addressed the prognostic value of longitudinal motion markers (velocity, strain, and strain rate) in predicting outcome in heart failure patients. Methods and Results-The study included 125 consecutive symptomatic heart failure patients (63Ϯ16 years, 77% male, LVEFϭ31Ϯ10%). All patients underwent a complete echocardiographic and clinical examination, and brain natriuretic peptide level was assessed in 93 patients. Longitudinal myocardial velocity by tissue Doppler imaging, global-, and strain rate by speckle tracking were computed from apical views (4-, 3-, and 2-chambers views) and compared with the occurrence of major adverse cardiac events. On the whole, peak longitudinal velocity, global-, and strain rate averaged 5Ϯ2 cm/s (range, 1 to 9), Ϫ8Ϯ3% (range, Ϫ3 to Ϫ18), and Ϫ0.33Ϯ0.16 s Ϫ1 (range, Ϫ0.83 to Ϫ0.05), respectively. During the follow-up period (266Ϯ177 days), major adverse cardiac events occurred in 47 (38%) patients (15 deaths, 29 recurrent heart failure, and 4 heart transplantations). By univariable analysis using Cox model global-, strain rate, and LVEF were associated with the occurrence of major adverse cardiac events, whereas only global-remained independently predictive of outcome by multivariate analysis. Conclusions-In the heart failure population, longitudinal global strain by speckle tracking is superior to LVEF and other longitudinal markers in identifying patients with poor outcome. (Circ Cardiovasc Imaging. 2010;3:249-256.)

The FRANCE-2 registry represents the largest database available on late results of TAVR. Late mortality is largely related to noncardiac causes. Incidence rates of severe events are low after the first month. Valve performance remains stable over time.

GLS has an incremental value over LVEF for risk stratification in patients referred for cardiac surgery.