Global Longitudinal Strain to Predict Mortality in Acute Heart Failure

Study Questions:

What is the prognostic value of global longitudinal strain (GLS) among patients with heart failure (HF)?


GLS was measured in 4,172 consecutive patients with acute HF. Patients were categorized as HF with reduced (left ventricular ejection fraction [LVEF] <40%), midrange (LVEF 40-49%), or preserved ejection fraction (LVEF ≥50%); and as having mildly (GLS >12.6%), moderately (8.1% < GLS < 12.5%), or severely (GLS ≤8.0%) reduced strain. The primary endpoint was 5-year all-cause mortality.


Mean GLS was 10.8 ± 5.0%, and mean LVEF was 40 ± 16%. Overall, 1,740 (40.4%) patients had died at 5 years. Patients with reduced LVEF had slightly higher mortality than those with midrange or preserved EF (41%, 38%, and 39%, respectively; log-rank p = 0.03), whereas patients with reduced strain had significantly higher mortality (mortality for severely reduced GLS 49%, moderately reduced GLS 38%, and mildly reduced GLS 34%; log-rank p < 0.001). In multivariable analysis, each 1% increase in GLS was associated with a 5% decreased risk for mortality (p < 0.001). Patients with moderately (hazard ratio, 1.31; 95% confidence interval, 1.13-1.53) and severely reduced GLS (hazard ratio, 1.61; 95% confidence interval, 1.36-1.91) had higher mortality, but LVEF was not associated with mortality.


Among patients with acute HF, GLS has greater prognostic value than LVEF. The authors suggest that GLS should be considered as the standard measurement in all patients with HF.


HF currently is classified according to LVEF (preserved, midrange, or reduced); however, the prognosis of patients with HF with preserved LVEF (HFpEF) is similar to patients with HF with reduced LVEF. This study found that most patients with HFpEF had reduced GLS, reinforcing the concept that LVEF is an imperfect measure of LV systolic function. The correlation between GLS and mortality (regardless of LVEF) suggests that GLS should be incorporated with other clinical measures in the assessment of all patients with HF.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Chronic Heart Failure, Echocardiography/Ultrasound

Keywords: Diagnostic Imaging, Echocardiography, Heart Failure, Heart Failure, Diastolic, Heart Failure, Systolic, Mortality, Prognosis, Stroke Volume, Systole, Ventricular Function, Left

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