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Updated: Aug 7, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Combined Left Ventricular and Left Atrial Strain Assessment for Long-Term Risk Stratification in Heart Failure With
Aleksandra Maksimovic1, Sofija Aleksandra Neskovic1, Milica Scepanovic1
1Department of Cardiology, Clinical Hospital Centre Zemun, Belgrade, Serbia.
Insights
Combining left ventricular global longitudinal strain (LV GLS) and left atrial reservoir strain (LASr) improves risk stratification in heart failure with reduced ejection fraction (HFrEF). This combined assessment identifies distinct patient risk phenotypes for better mortality prediction.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left ventricular global longitudinal strain (LV GLS) and left atrial reservoir strain (LASr) are known predictors of adverse outcomes in heart failure with reduced ejection fraction (HFrEF).
- The combined prognostic value of LV GLS and LASr in HFrEF patients has not been fully explored.
Purpose of the Study:
- To evaluate the prognostic significance of combined LV GLS and LASr assessment in patients hospitalized with decompensated HFrEF.
- To determine if combined strain parameters enhance risk stratification compared to individual measures.
Main Methods:
- Retrospective analysis of 341 HFrEF patients undergoing speckle-tracking echocardiography.
- Assessment of LV GLS and LASr, with ROC analysis to define optimal cutoff values (7.3% for GLS, 9.0% for LASr).
- Cox proportional hazards models used to assess association with all-cause mortality over a median 59-month follow-up.
Main Results:
- A total of 238 patients (70%) died during follow-up.
- Both LV GLS and LASr were independently associated with all-cause mortality after multivariable adjustment.
- Patients with impaired LV GLS and LASr had the highest mortality risk; those with least impairment had the best outcomes, indicating enhanced risk stratification.
Conclusions:
- Both LV GLS and LASr are independent predictors of mortality in HFrEF.
- Combined assessment of LV GLS and LASr provides enhanced risk stratification, identifying distinct risk phenotypes in HFrEF patients.
Purpose:
Left ventricular (LV) global longitudinal strain (GLS) and left atrial reservoir strain (LASr) are established predictors of adverse outcomes in heart failure with reduced ejection fraction (HFrEF), but the prognostic value of their combined assessment has not been fully elucidated.
Methods:
This retrospective study included 341 patients hospitalized with decompensated HFrEF who underwent speckle-tracking echocardiography for assessment of LV GLS and LASr. Receiver operating characteristic (ROC) analysis with Youden index optimization was applied to determine optimal strain cutoff values and develop a combined strain classification model. Cox proportional hazards models were used to identify parameters associated with all-cause mortality. LV GLS was analyzed using absolute values.
Results:
During a median follow-up of 59 months, 238 patients (70%) died. In univariable analysis, both LV GLS and LASr were associated with mortality. After multivariable adjustment, both remained independently associated with mortality (GLS: adjusted HR 0.945, 95% CI 0.902-0.991, p = 0.019; LASr: adjusted HR 0.972, 95% CI 0.953-0.992, p = 0.006). ROC analysis identified optimal cutoff values of 7.3% for LV GLS and 9.0% for LASr. Patients with concomitant marked impairment of both strain parameters exhibited the highest mortality risk, whereas those with the least impaired ventricular and atrial strain had the most favorable outcomes. Patients with pronounced impairment of either parameter alone demonstrated intermediate survival.
Conclusion:
In patients hospitalized with HFrEF, both LV GLS and LASr were independently associated with all-cause mortality. Their combined assessment may identify distinct risk phenotypes and provide enhanced risk stratification beyond either parameter alone.
