Author + information
- Received December 28, 2017
- Revision received February 15, 2018
- Accepted February 25, 2018
- Published online April 30, 2018.
- Jin Joo Park, MD, PhDa,
- Jun-Bean Park, MD, PhDb,
- Jae-Hyeong Park, MD, PhDc and
- Goo-Yeong Cho, MD, PhDa,∗ ()
- aCardiovascular Center and Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- bDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- cDepartment of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- ↵∗Address for correspondence:
Dr. Goo-Yeong Cho, Cardiovascular Center/Seoul National University Bundang Hospital, Seoul National University, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea.
Background Heart failure (HF) is currently classified according to left ventricular ejection fraction (LVEF); however, the prognostic value of LVEF is controversial. Myocardial strain is a prognostic factor independently of LVEF.
Objectives The authors sought to evaluate the prognostic value of global longitudinal strain (GLS) in patients with HF.
Methods GLS was measured in 4,172 consecutive patients with acute HF. Patients were categorized as either HF with reduced (LVEF <40%), midrange (LVEF 40% to 49%), or preserved ejection fraction (LVEF ≥50%) and were also classified 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.
Results Mean GLS was 10.8%, and mean LVEF was 40%. Overall, 1,740 (40.4%) patients had died at 5 years. Patients with reduced ejection fraction had slightly higher mortality than those with midrange or preserved ejection fraction (41%, 38%, and 39%, respectively; log-rank p = 0.031), whereas patients with reduced strain had significantly higher mortality (severely reduced GLS, 49%; moderately reduced GLS, 38%; 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 moderate (hazard ratio: 1.31; 95% confidence interval: 1.13 to 1.53) and severe GLS reductions (hazard ratio: 1.61; 95% confidence interval: 1.36 to 1.91) had higher mortality, but LVEF was not associated with mortality.
Conclusions In patients with acute HF, GLS has greater prognostic value than LVEF. Therefore, the authors suggest that GLS should be considered as the standard measurement in all patients with HF. This new concept needs validation in further studies.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 28, 2017.
- Revision received February 15, 2018.
- Accepted February 25, 2018.
- 2018 American College of Cardiology Foundation
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