Association of Global Longitudinal Strain With Clinical Status and Mortality in Patients With Chronic Heart Failure

Abstract

IMPORTANCEGlobal longitudinal strain (GLS) is an emerging echocardiographic biomarker of cardiac function in heart failure (HF). Evidence from large-scale studies comprehensively investigating GLS for its association with clinical phenotypes and mortality in asymptomatic and symptomatic chronic HF is limited.OBJECTIVE To assess the factors associated with GLS and its prognostic value in patients with chronic HF.

Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

“…A study conducted on more than 2440 individuals showed that, in patients with HFrEF, LV GLS was associated not only with clinical outcome but also with the severity of HF showed by NT-proBNP, with age and AF burden. 34 …”

SGLT2 Inhibition in HFpEF. Do We Need More Quantitative and Load Independent Metrics to Understand the Results of the EMPEROR-Preserved Trial?

“…From a pathophysiologic point of view, LVEF is a crude and load-dependent marker for cardiac efficiency (5,6), whereas myocardial strain by echocardiography and advanced quantitative CMR, recently exhibited important value for the non-invasive assessment of myocardial fibrosis and incremental prognostic value beyond LVEF in heart failure patients (6)(7)(8). Thus, global longitudinal strain (GLS) was associated with clinical heart failure status, the level of neurohormonal activation and with long-term cardiac mortality in patients with asymptomatic and symptomatic heart failure (6).…”

“…From a pathophysiologic point of view, LVEF is a crude and load-dependent marker for cardiac efficiency (5,6), whereas myocardial strain by echocardiography and advanced quantitative CMR, recently exhibited important value for the non-invasive assessment of myocardial fibrosis and incremental prognostic value beyond LVEF in heart failure patients (6)(7)(8). Thus, global longitudinal strain (GLS) was associated with clinical heart failure status, the level of neurohormonal activation and with long-term cardiac mortality in patients with asymptomatic and symptomatic heart failure (6). In addition, the presence of "normal" myocardium (defined as percentage of myocardial segments exhibiting a strain value ≤ −17%) by advanced quantitative CMR using Fast Strainencoded Cardiac Magnetic Resonance (fast-SENC), recently demonstrated incremental value for the prediction of clinical outcomes beyond LVEF in an all-comer cohort of heart failure patients (7).…”

CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter–Defibrillator in Non-Ischemic Cardiomyopathy

“…When combined with LVEF, the prognostic value could be increased even further [81]. More recently, Tröbs et al showed an association of GLS with cardiac death independent of cardiac function and NYHA class in a cohort of 2186 patients with chronic HF [82]. However, few studies investigated the prognostic value of impaired GLS on arrhythmic events of patients with NICM, and randomized trials with a high number of patients and focus on NICM or, even more specific, DCM alone are lacking.…”