Predictive value of global longitudinal strain and geometry of left ventricle in patients with noncompaction cardiomyopathy

Aim. To assess the prognostic role of a decrease in longitudinal strain and an increase in the left ventricular sphericity index as predictors of NYHA class III heart failure (HF) progression, requiring hospitalization in a cohort of patients with noncompaction cardiomyopathy (NCM) in combination with dilated cardiomyopathy (DCM).Material and methods. We examined 90 patients with a combination of NCM and DCM aged 18 to 72 years (median age, 41 years; men — 73; women — 17), who, in addition to conventional echocardiographic and magnetic resonance imaging (MRI) characteristics, were studied for two-dimensional strain and global longitudinal strain (GLS) parameters and left ventricular sphericity index (SI) using cardiac MRI. The endpoints included NYHA class III HF progression, requiring hospitalization.Results. During the follow-up period (median follow-up, 36 (6; 152) months) in 59 of 90 (65,5%) patients with NCM in combination with DCM, symptoms progressed to NYHA class III HF, requiring hospitalization. Multivariate analysis showed following independent risk factors for HF-related hospitalization: a decrease in GLS <10% (hazard ratio (HR), 5,1; 95% confidence interval (CI), 1,6-16,7, p<0,007) and an increase in SI >0,5 (HR, 9,0; 95% CI, 2,2-37,8, p<0,003) .The 3-year event-free survival rate for patients with one risk factor (GLS, %<10 and SI <0,5; GLS, %>10 and SI >0,5) was 79,2±16,9% and 64,4±24,6%, respectively, while for the group with two risk factors (GLS, %<10 and SI>0,5) — 12,3%.Conclusion. Global longitudinal strain characteristics according to 2D Strain echocardiography and SI according to cardiac MRI are associated with adverse events in NCM and DCM combination and can be used to identify patients with a high risk of HF progression to NYHA class III, requiring hospitalization.

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Prognostic value of global longitudinal strain versus mitral annular plane systolic excursion in patients with ischemic heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1011 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Liu ◽

C Wagner ◽

K Hu ◽

B Lengenfelder ◽

G Ertl ◽

...

Keyword(s):

Heart Failure ◽

Longitudinal Strain ◽

Nyha Class ◽

Global Longitudinal Strain ◽

Ischemic Heart ◽

Ischemic Heart Failure ◽

Class Iii ◽

Heart Failure Patients ◽

All Cause Mortality

Abstract Background Mitral annular plane systolic excursion (MAPSE) derived from M-mode echocardiography is a classical risk factor of clinical outcome in heart failure patients. Two-dimensional-echocardiography (2DE) derived global longitudinal strain (GLS) is also related to outcome in patients with heart failure. This study aimed to compare the prognostic performance between GLS and MAPSE in ischemic heart failure patients with reduced ejection fraction. We sought to test the hypothesis that GLS might be superior to MAPSE as a risk stratification marker in these patients. Methods In total, 1277 ischemic heart failure patients with reduced left ventricular ejection fraction (LVEF<50%), referred to our department between 2009 and 2017, were included in this retrospective study. Offline standard echocardiographic measurements including MAPSE and GLS were performed. Average MAPSE of septal and lateral walls (MAPSE_Avg) was calculated. GLS was derived from the segmental averaging (18-segment) of the three apical views. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoint was defined as all-cause mortality or heart transplantation (HTx). Results At baseline visit, mean age was 70±11 years and 79.6% were men. NYHA class III-IV were identified in 33.5% of patients. Coronary artery disease was confirmed by coronary angiography. 63.0% patients had a history of myocardial infarction, 32.1% underwent PCI, and 16.8% underwent coronary artery bypass grafting. Over a median follow-up period of 26 (14–39) months, 369 (28.9%) patients died and 5 (0.4%) underwent HTx. Median LVEF was 39% (32–45%), and there were 48.0% patients with LVEF between 40–49%, 32.3% patients with LVEF between 30–49% and 19.7% patients with LVEF <30%. MAPSE_Avg was 8.0 (6.5–10.0) mm and median GLS was −9.9% (−7.7 to −12.3%). Clinical covariates significantly associated with all-cause mortality in this cohort included age (HR=1.048), NYHA class III-IV (HR=1.800), AF (HR=1.567), diabetes (HR=1.262), dyslipidemia (HR=0.657), hyperuricemia (HR=1.861), peripheral vascular disease (HR 1.858), chronic respiratory diseases (HR=1.680), and renal dysfunction (HR=2.705). Multivariable Cox regression analysis showed that reduced MAPSE_Avg (<7mm, HR=1.431, 95% CI 1.146–1.786) and reduced GLS (<8.3%, HR=1.519, 95% CI 1.230–1.875) were independent predictors of all-cause mortality after adjustment of above-mentioned clinical confounders. ROC curves demonstrated that the predictive performance of all-cause mortality among LVEF, MAPSE_Avg, and GLS were similar (AUC=0.608, 0.601, and 0.616, respectively, all P<0.001). Conclusions Both 2DE-guided GLS and MAPSE could provide additional prognostic information in ischemic heart failure patients with reduced LVEF. Prognostic performance of GLS, MAPSE, and LVEF is similar in ischemic heart failure patients with reduced LVEF. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Federal Ministry of Education and Research

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Abstract 20072: Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain and Late Gadolinium Enhancement in Patients with Dilated Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.20072 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Misato Chimura ◽

Tetsuari Onishi ◽

Hiroya Kawai ◽

Shinishiro Yamada ◽

Yoshinori Yasaka

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Prognostic Value ◽

Longitudinal Strain ◽

Nyha Class ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Gadolinium Enhancement ◽

Incremental Prognostic Value

Introduction: Reduced left ventricular (LV) global longitudinal strain (GLS) by two-dimensional speckle-tracking (2DST) echocardiography and late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) have been reported to be associated with unfavorable outcome in patient with heart failure (HF). We investigated to assess these 2 markers as prognostic parameters over conventional HF markers in patients with dilated cardiomyopathy (DCM). METHODS: We studied consecutive 179 DCM patients (Age 61±15 years, 121 males, LV ejection fraction (LVEF) 33±9%, NYHA class I: n= 0; II: n=71; III: n=107; IV: n=1) who underwent CMR and echocardiography with conventional assessment including LV end-diastolic and end-systolic volume (LVEDV, LVESV), LVEF and mitral regurgitation grade (MR), and with 2DST analysis of GLS. Brain natriuretic peptide (BNP) was measured. Outcome was assessed according to death and hospitalization with heart failure in the follow-up period for 3.8±2.5 years. RESULTS: There were 7 cardiac deaths and 40 HF hospitalizations in the follow-up period. Univariate Cox proportional hazard regression analysis showed NYHA class, systolic blood pressure, diastolic blood pressure, BNP, LVEDV, LVESV, LVEF, MR, GLS and positive LGE were significantly associated with outcome. Multivariate Cox proportional hazards regression analysis revealed GLS and positive LGE (p<0.05 for both) were independent predictors of outcome. Dividing all 179 patients into 4 groups with the median of GLS (-8.3%) and the presence or absence of LGE, Kaplan-Meier analysis showed worse GLS predicted adverse events in patients with and without LGE (p<0.05 for both). GLS and LGE provide additional benefit over conventional parameters (Age, NYHA class, LVEF and BNP). CONCLUSIONS: Risk stratification with LGE and GLS is useful to predict long-term outcome in DCM patients. These 2 markers provide incremental prognostic value to conventional HF markers.

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P985 The use of strain analysis in patients under cardiotoxic chemotherapy: possible early detection of cardiotoxicity

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.614 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Ozturk ◽

D Validyev ◽

U M Becher ◽

G Nickenig ◽

V Tiyerili

Keyword(s):

Heart Failure ◽

Longitudinal Strain ◽

Independent Predictor ◽

Nyha Class ◽

Global Longitudinal Strain ◽

Strain Analysis ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Chamber View

Abstract Cardiotoxicity is a frequent side effect of chemotherapy leading to impaired outcomes in cancer survivors. Because of that cardiooncology has recently gained more importance in clinical practice. We aim to echocardiographically evaluate the development of cardiotoxicity and to detect early signs for preventing severe cardiomyopathies by repeated strain analysis. We included 80 patients (46.7 ± 14.7 years, 75% female) under diverse cardiotoxic chemotherapies (43.7% breast cancer, 43.7% haematological malignancy, 12.5% others). All patients underwent echocardiography before and during treatment. Follow-up echocardiography was performed approximately 5.5 ± 1.2 months after the first application of the chemotherapy. The apical four-chamber view was used to perform strain analysis employing dedicated and automated offline software as shown previously. Eight patients deceased due to oncological complications during follow up. Twelve patients showed significant reduced left ventricle ejection fraction (LVEFbaseline 63.2 ± 4.5%, LVEFFollow-up 48.6 ± 7.8%, p = 0.02) correlated with decrease in left ventricular global longitudinal strain (LV-GLSbaseline 17.1 ± 5.2%, LV-GLSFollow-up 9.7 ± 3.2%, p = 001). All of these patients presented heart failure symptoms, mostly with dyspnoea (85% functional NYHA class > II) and oedema (65%). In 15 patients we found a reduction of left ventricular global longitudinal strain from <5% without relevant reduction of LVEF. However, these patients showed also heart failure symptoms. During follow up 20 patients had to be admitted due to decompensated heart failure. Four patients deceased due to cardiovascular causes. Delta LV-GLS (LV-GLSbaseline – LV-GLSFollow-up) was found to be strongest independent predictor of mortality. Baseline LV-GLS < 15% was found to be associated with mortality and frequent rehospitalisation. Solely LVEF is insufficient to detect cardiotoxicity and to estimate prognosis of patients under cardiotoxic chemotherapy. In our small patient collective we found baseline LV-GLS <15% to be an adequate parameter for prognosis estimation and delta LV-GLS > 5% a strongest independent predictor for mortality in patients with preserved LVEF under cardiotoxic chemotherapy.

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Early change in left atrial and left ventricular strain predicts sinus rhythm maintenance after cardioversion

European Heart Journal ◽

10.1093/ehjci/ehaa946.0142 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Kupczynska ◽

D Miskowiec ◽

B Michalski ◽

L Szyda ◽

K Wierzbowska-Drabik ◽

...

Keyword(s):

Sinus Rhythm ◽

Left Atrial ◽

Speckle Tracking ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Recurrence Risk ◽

Left Ventricular ◽

Mechanical Function ◽

Af Recurrence

Abstract Background Atrial fibrillation (AF) impairs mechanical function of the heart, especially atria and restoration of sinus rhythm (SR) leads to improvement of mechanics. The predicting role of changes in strain parameters for AF recurrence is not established yet. Purpose To analyse changes in left atrial (LA) and left ventricular (LV) mechanical function after conversion to SR and their prognostic values for AF recurrence during 24 months follow-up. Methods Prospective study involved 59 patients after successful electrical cardioversion (EC) because of nonvalvular AF (mean age 65±4 years, 47% female). Speckle tracking analysis (STE) was applied to calculate longitudinal strain of LV and LA before EC and within 24 hours after restoration of SR and additionally total left heart strain (TS) defined as a sum of absolute peak LV and LA strain. We calculated change in strain between AF and SR analyses expressed as delta (Δ). During follow-up we noticed AF recurrence in 42 (71%) patients, most of them (93%) during 1st year after EC. Median time of AF recurrence was 3 months. Results We noticed significant immediate post-EC improvement in peak LA longitudinal strain (PALS) and LV global longitudinal strain (LVGLS) (table). Unlike CHA2DS2-VASc score, strain parameters were predictors of AF recurrence. Every 1% increment in ΔLVGLS was related with 13% increase in AF recurrence risk (p=0.02) and every 1% increment in ΔPALS and ΔTS were related with 9% decrease in AF recurrence risk (p=0.007 and p=0.0014, respectively). Multivariate analysis revealed ΔTS as a strongest predictor with 9% decrease in AF risk per every 1% increment. The criterion of ΔTS ≤7.5% allows to predict AF recurrence with 81% sensitivity and 63% specificity. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR and these absolute changes in LVGLS as well as PALS can predict AF recurrence, with optimal stratification by novel parameter - TS. Funding Acknowledgement Type of funding source: None

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Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

European Heart Journal ◽

10.1093/ehjci/ehaa946.0139 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Philabout ◽

L Soulat-Dufour ◽

I Benhamou-Tarallo ◽

S Lang ◽

S Ederhy ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Cardiac Rhythm ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cardiac Chamber ◽

Deformation Imaging ◽

And Function

Abstract Background Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome. Purpose To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6). Methods In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7) Results In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p<0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p<0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p<0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure). Conclusion Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm. Evolution of strain between M0 and M6 Funding Acknowledgement Type of funding source: None

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Baseline global longitudinal strain predictive of anthracycline-induced cardiotoxicity

Cardio-Oncology ◽

10.1186/s40959-021-00090-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Raquel Araujo-Gutierrez ◽

Kalyan R. Chitturi ◽

Jiaqiong Xu ◽

Yuanchen Wang ◽

Elizabeth Kinder ◽

...

Keyword(s):

Risk Factors ◽

Cancer Therapy ◽

Confidence Interval ◽

Longitudinal Strain ◽

Proportional Hazards ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Abstract Background Cancer therapy-related cardiac dysfunction (CTRD) is a major source of morbidity and mortality in long-term cancer survivors. Decreased GLS predicts decreased left ventricular ejection fraction (LVEF) in patients receiving anthracyclines, but knowledge regarding the clinical utility of baseline GLS in patients at low-risk of (CTRD) is limited. Objectives The purpose of this study was to investigate whether baseline echocardiographic assessment of global longitudinal strain (GLS) before treatment with anthracyclines is predictive of (CTRD) in a broad cohort of patients with normal baseline LVEF. Methods Study participants comprised 188 patients at a single institution who underwent baseline 2-dimensional (2D) speckle-tracking echocardiography before treatment with anthracyclines and at least one follow-up echocardiogram 3 months after chemotherapy initiation. Patients with a baseline LVEF <55% were excluded from the analysis. The primary endpoint, (CTRD), was defined as an absolute decline in LVEF > 10% from baseline and an overall reduced LVEF <50%. Potential and known risk factors were evaluated using univariable and multivariable Cox proportional hazards regression analysis. Results Twenty-three patients (12.23%) developed (CTRD). Among patients with (CTRD), the mean GLS was -17.51% ± 2.77%. The optimal cutoff point for (CTRD) was -18.05%. The sensitivity was 0.70 and specificity was 0.70. The area under ROC curve was 0.70. After adjustment for cardiovascular and cancer therapy related risk factors, GLS or decreased baseline GLS ≥-18% was predictive of (CTRD) (adjusted hazards ratio 1.17, 95% confidence interval 1.00, 1.36; p = 0.044 for GLS, or hazards ratio 3.54; 95% confidence interval 1.34, 9.35; p = 0.011 for decreased GLS), along with history of tobacco use, pre-chemotherapy systolic blood pressure, and cumulative anthracycline dose. Conclusions Baseline GLS or decreased baseline GLS was predictive of (CTRD) before anthracycline treatment in a cohort of cancer patients with a normal baseline LVEF. This data supports the implementation of strain-protocol echocardiography in cardio-oncology practice for identifying and monitoring patients who are at elevated risk of (CTRD).

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Feature-tracking cardiac magnetic resonance left ventricular global longitudinal strain improves 6 months after kidney transplantation associated with reverse remodeling, not myocardial tissue characteristics

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02284-2 ◽

2021 ◽

Author(s):

Maurício Fregonesi Barbosa ◽

Mariana Moraes Contti ◽

Luis Gustavo Modelli de Andrade ◽

Alejandra del Carmen Villanueva Mauricio ◽

Sergio Marrone Ribeiro ◽

...

Keyword(s):

Kidney Transplantation ◽

Cardiac Magnetic Resonance ◽

Feature Tracking ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Reverse Remodeling ◽

Myocardial Tissue ◽

Tissue Characteristics

AbstractTo determine whether left ventricular (LV) global longitudinal strain (GLS) measured by feature-tracking (FT) cardiac magnetic resonance (CMR) improves after kidney transplantation (KT) and to analyze associations between LV GLS, reverse remodeling and myocardial tissue characteristics. This is a prospective single-center cohort study of kidney transplant recipients who underwent two CMR examinations in a 3T scanner, including cines, tagging, T1 and T2 mapping. The baseline exam was done up to 10 days after transplantation and the follow-up after 6 months. Age and sex-matched healthy controls were also studied for comparison. A total of 44 patients [mean age 50 ± 11 years-old, 27 (61.4%) male] completed the two CMR exams. LV GLS improved from − 13.4% ± 3.0 at baseline to − 15.2% ± 2.7 at follow-up (p < 0.001), but remained impaired when compared with controls (− 17.7% ± 1.5, p = 0.007). We observed significant correlation between improvement in LV GLS with reductions of left ventricular mass index (r = 0.356, p = 0.018). Improvement in LV GLS paralleled improvements in LV stroke volume index (r = − 0.429, p = 0.004), ejection fraction (r = − 0.408, p = 0.006), global circumferential strain (r = 0.420, p = 0.004) and global radial strain (r = − 0.530, p = 0.002). There were no significant correlations between LV GLS, native T1 or T2 measurements (p > 0.05). In this study, we demonstrated that LV GLS measured by FT-CMR improves 6 months after KT in association with reverse remodeling, but not native T1 or T2 measurements.

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Abstract 19346: Peak Oxygen Consumption Predicts Outcome in Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.130.suppl_2.19346 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Carla Contaldi ◽

Raffaella Lombardi ◽

Alessandra Giamundo ◽

Sandro Betocchi

Keyword(s):

Heart Failure ◽

Oxygen Consumption ◽

Hypertrophic Cardiomyopathy ◽

Nyha Class ◽

Left Ventricular ◽

Exercise Intolerance ◽

Peak Oxygen Consumption ◽

Class Iii ◽

Asymptomatic Patients

Introduction: Peak oxygen consumption (VO 2 ) has a strong and independent prognostic value in systolic heart failure; in contrast no data support its prognostic role in hypertrophic cardiomyopathy (HCM). Hypothesis: We assess if peak VO 2 is a long-term predictor of outcome in HCM. Methods: We studied 92 HCM patients (40±15 years). Peak VO 2 was expressed as percentage (%) of the predicted value. Follow up was 76±57 months. The primary composite endpoint (CE) was atrial fibrillation, progression to NYHA class III or IV, myotomy-myectomy (MM), heart transplantation (HT) and cardiac death. An ancillary endpoint (HFE) included markers of heart failure (progression to NYHA class III or IV, MM and HT). Results: At baseline, 62% of patients were asymptomatic, 35% NYHA class II and 3% NYHA class III; 26% had left ventricular outflow tract obstruction. During follow up, 30 patients met CE with 43 events. By multivariate Cox survival analysis, we analyzed 2 models, using the CE, and in turn HFE. For CE, maximal left atrial diameter (LAD) (HR: 1.12; 95% CI: 1.04 to 1.22), maximal wall thickness (MWT) (HR: 0.14; 95% CI: 1.04 to 1.23) and % predicted peak VO 2 (HR: -0.03; 95% CI: 0.95 to 0.99) independently predicted outcome (overall, p<0.0001). For HFE, maximal LAD (HR:0.31; 95% CI: 1.09 to 1.70), MWT (HR: 0.35; 95% CI: 1.08 to 1.84) and % predicted peak VO 2 (HR: -0.06; 95% CI: 0.89 to 0.98) independently predicted outcome (overall, p<0.0001). Only 19% of mildly symptomatic or asymptomatic patients with % predicted peak VO 2 >80% had events, as opposed to 53% of them with % predicted peak VO 2 < 55% (p= 0.04). Event-free survival for both endpoints was significantly lower in patients with % predicted peak VO 2 < 55% as compared to those with it between 55 and 80 and >80% , Figure. Conclusion: In mildly or asymptomatic patients severe exercise intolerance may precede clinical deterioration. In HCM, peak VO 2 provides excellent risk stratification with a high event rate in patients with % predicted value <55%.

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P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.819 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

E Sakaguchi ◽

A Yamada ◽

M Hoshino ◽

K Takada ◽

N Hoshino ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Stable Condition ◽

Left Ventricular ◽

Operating Characteristics ◽

Cardiac Events

Abstract Purposes We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission. Methods We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (> 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events. Results Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p < 0.0001, log-rank). Conclusion A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.

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