Related Experiment Video
Updated: Oct 8, 2025
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Prognostic Value of Global Longitudinal Strain in Patients With Heart Failure With Improved Ejection Fraction
Satit Janwanishstaporn1, Jae Yeong Cho2, Siting Feng3
1Cardiology Department, University of California Medical Center and Sulpizio Cardiovascular Center, La Jolla, California, USA; Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Global longitudinal strain (GLS) predicts future heart failure (HF) events in patients with improved ejection fraction (HFimpEF). Higher GLS indicates a lower risk of cardiovascular mortality or HF hospitalization.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left ventricular ejection fraction (LVEF) can improve in patients with heart failure (HF) with reduced ejection fraction (HFrEF).
- The clinical trajectory of patients with HF who experience improved LVEF (HFimpEF) is highly variable.
- Global longitudinal strain (GLS) is a sensitive measure of left ventricular (LV) systolic function that may predict adverse events in HFimpEF patients.
Purpose of the Study:
- To investigate the association between GLS and the natural history of HFimpEF.
- To determine if GLS is an independent predictor of cardiovascular outcomes in HFimpEF.
Main Methods:
- Retrospective analysis of 289 HF patients with initial LVEF <40% and improved LVEF ≥10% to >40% at index echocardiogram.
- GLS was measured using 2D speckle-tracking on the index echocardiogram.
- Primary outcome: time to first occurrence of cardiovascular mortality or HF hospitalization/emergency treatment.
Main Results:
- Median absolute GLS (aGLS) was 12.7% and median LVEF was 52% at index echocardiogram.
- Patients with aGLS above the median had a lower incidence of the primary endpoint (21% vs. 34%, P=0.014).
- Each 1% increase in aGLS was associated with a 14% lower likelihood of the composite endpoint (HR 0.86, P<0.001), persisting after adjustment (HR 0.90, P=0.01).
- Lower aGLS correlated with increased likelihood of LVEF deterioration.
Conclusions:
- GLS is a significant predictor of future adverse events in patients with HFimpEF.
- GLS may aid in risk stratification and management of HFimpEF patients.
- GLS provides prognostic information beyond LVEF in this population.
Objectives:
The authors sought to determine whether global longitudinal strain (GLS) is independently associated with the natural history of patients with heart failure (HF) with improved ejection fraction (HFimpEF).
Background:
Left ventricular (LV) ejection fraction (EF) often improves in patients with reduced EF. The clinical course of patients with HFimpEF, however, is quite variable. GLS, a sensitive indicator of LV systolic function, could help predict risk of future events in this population.
Methods:
Retrospective analysis of HF patients with LVEF >40% on index echocardiogram who had LVEF <40% on initial study and improvement of ≥10%. GLS was assessed by 2-dimensional speckle-tracking software on index echocardiography. Primary outcome was time to first occurrence of cardiovascular mortality or HF hospitalization/emergency treatment.
Results:
Of the 289 patients with HFimpEF, median absolute values of GLS (aGLS) and LVEF from index echocardiography were 12.7% (IQR: 10.8%-14.7%) and 52% (IQR: 46%-58%), respectively. Over 53 months following index echocardiography, the primary endpoint occurred less frequently in patients with aGLS above the median than below it (21% vs 34%; P = 0.014); HR of 0.51; 95% CI: 0.33-0.81; P = 0.004. When assessed as a continuous variable, each 1% increase in aGLS on index echocardiogram was associated with a lower likelihood of the composite endpoint; HR of 0.86; 95% CI: 0.79-0.93; P < 0.001, an association that persisted after multivariable adjustment; HR 0.90; 95% CI: 0.82-0.97; P = 0.01. Lower aGLS was associated with increased likelihood of deterioration in LVEF.
Conclusions:
In patients with HFimpEF, GLS is a strong predictor for future HF events and deterioration in cardiac function.
More Related Videos
07:21Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
11:50High-frequency High-resolution Echocardiography: First Evidence on Non-invasive Repeated Measure of Myocardial Strain, Contractility, and Mitral Regurgitation in the Ischemia-reperfused Murine Heart
Published on: July 9, 2010
Related Concept Videos
01:17Pathophysiology of Heart Failure
01:29Heart Failure II: Pathophysiology
01:30Heart Failure IV: Classification and Diagnostic Evaluation