Related Experiment Video
Updated: Aug 12, 2025
Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Prognostic value of temporal patterns of global longitudinal strain in patients with chronic heart failure
Sabrina Abou Kamar1,2, Yaar S Aga1,3, Marie de Bakker1
1Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.
Insights
Repeated global longitudinal strain (GLS) measurements in chronic heart failure (HF) patients offer prognostic value, but single GLS measurements are sufficient. Temporal GLS patterns do not add prognostic information beyond NT-proBNP levels.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Chronic heart failure (HF) management relies on prognostic markers.
- Left ventricular ejection fraction (LVEF) and N-terminal pro B-type natriuretic peptide (NT-proBNP) are established markers.
- Global longitudinal strain (GLS) is an emerging echocardiographic parameter for assessing cardiac function.
Purpose of the Study:
- To determine if repeated global longitudinal strain (GLS) measurements provide additional prognostic information compared to single GLS measurements, repeated left ventricular ejection fraction (LVEF), and NT-proBNP in chronic heart failure (HF) patients.
- To evaluate the incremental prognostic value of temporal GLS trajectories in predicting adverse cardiovascular events.
Main Methods:
- Prospective observational study involving 173 clinically stable chronic HF patients.
- Serial echocardiography performed every six months over a median follow-up of 2.7 years.
- Composite endpoint included HF hospitalization, left ventricular assist device, heart transplantation, or cardiovascular death. Analysis used Cox and joint models.
Main Results:
- Both single GLS measurements and temporal GLS trajectories were significantly associated with adverse events.
- Repeated GLS measurements retained prognostic value, unlike repeated LVEF measurements.
- The prognostic association of GLS diminished when adjusted for NT-proBNP, indicating NT-proBNP as a stronger independent predictor.
Conclusions:
- Single GLS measurements provide sufficient prognostic information in chronic HF patients, negating the need for repeated measurements.
- Temporal GLS patterns do not offer additional prognostic value beyond NT-proBNP.
- NT-proBNP is a more robust independent predictor of adverse outcomes in this cohort.
Background:
We investigated whether repeatedly measured global longitudinal strain (GLS) has incremental prognostic value over repeatedly measured left ventricular ejection fraction (LVEF) and N-terminal pro B-type natriuretic peptide (NT-proBNP), and a single "baseline" GLS value, in chronic heart failure (HF) patients.
Methods:
In this prospective observational study, echocardiography was performed in 173 clinically stable chronic HF patients every six months during follow up. During a median follow-up of 2.7 years, a median of 3 (25th-75th percentile:2-4) echocardiograms were obtained per patient. The endpoint was a composite of HF hospitalization, left ventricular assist device, heart transplantation, cardiovascular death. We compared hazard ratios (HRs) for the endpoint from Cox models (used to analyze the first available GLS measurements) with HRs from joint models (which links repeated measurements to the time-to-event data).
Results:
Mean age was 58 ± 11 years, 76% were men, 81% were in New York Heart Association functional class I/II, and all had LVEF < 50% (mean ± SD: 27 ± 9%). The endpoint was reached by 53 patients. GLS was persistently decreased over time in patients with the endpoint. However, temporal GLS trajectories did not further diverge in patients with versus without the endpoint and remained stable during follow-up. Both single measurements and temporal trajectories of GLS were significantly associated with the endpoint [HR per SD change (95%CI): 2.15(1.34-3.46), 3.54 (2.01-6.20)]. In a multivariable model, repeatedly measured GLS maintained its prognostic value while repeatedly measured LVEF did not [HR per SD change (95%CI): GLS:4.38 (1.49-14.70), LVEF:1.14 (0.41-3.23)]. The association disappeared when correcting for repeatedly measured NT-proBNP.
Conclusion:
Temporal evolution of GLS was associated with adverse events, independent of LVEF but not independent of NT-proBNP. Since GLS showed decreased but stable values in patients with adverse prognosis, single measurements of GLS provide sufficient information for determining prognosis in clinical practice compared to repeated measurements, and temporal GLS patterns do not add prognostic information to NT-proBNP.
More Related Videos
09:05Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
