Global longitudinal strain can predict heart failure exacerbation in stable outpatients with ischemic left ventricular systolic dysfunction

Autoři: Damian Kaufmann aff001;  Małgorzata Szwoch aff001;  Joanna Kwiatkowska aff002;  Grzegorz Raczak aff001;  Ludmiła Daniłowicz-Szymanowicz aff001
Působiště autorů: Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland aff001;  Department of Pediatric Cardiology and Congenital Heart Defect, Medical University of Gdansk, Gdańsk, Poland aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225829



Despite advancements in pharmacological and device-based treatment, heart failure (HF) continues to impose an enormous burden for health care system worldwide. Decompensation of HF is one of the main causes of hospitalization, therefore the identification of patients with the highest risk of such complication is still of great clinical importance. The prognostic significance and utility of global longitudinal strain (GLS) has been previously studied in patients with the broad spectrum of cardiovascular diseases in various endpoints, however its role in assessing the risk of hospitalization due to HF exacerbation of optimally treated outpatients has not been fully explored. Therefore, the aim of the study was to verify whether the GLS of the left ventricle (LV) derived by 2D speckle tracking echocardiography has, independently of other well-known clinical parameters, an additional impact on the risk of HF decompensation in stable patients with LV systolic dysfunction of ischemic origin.


In 193 clinically stable HF outpatients with LV ejection fraction (LVEF) ≤ 50%, GLS, additionally to other clinical parameters, was analyzed. During 34 (14–71) months of follow-up, 58 patients were hospitalized due to HF decompensation (EVENT).


EVENT was significantly associated with age, QRS width, NYHA functional class, left atrium diameter, LV systolic and diastolic volume, LVEF, hemoglobin, brain natriuretic peptide, diuretic treatment, absence of beta-blockers, impaired renal function and history of diabetes in univariate Cox analyzes. GLS with pre-specified cut-off value of -9.4% was also significantly associated with the EVENT (HR 15.16; 95% CI 1.81–126.91). After adjusting for above-mentioned parameters GLS was still a significant predictor of hospitalization due to HF decompensation.


GLS measurement can provide incremental information on the risk of HF decompensation in stable outpatients with LV systolic dysfunction of ischemic origin.

Klíčová slova:

Cardiac atria – Diuretics – Echocardiography – Ejection fraction – Heart failure – Hemoglobin – Outpatients


1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive Summary: Heart Disease and Stroke Statistics—2016 Update. Circulation. 2016;133: 447–54. doi: 10.1161/CIR.0000000000000366 26811276

2. Savarese G, Lund LH. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017;3: 7. doi: 10.15420/cfr.2016:25:2 28785469

3. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2010;8: 30–41. doi: 10.1038/nrcardio.2010.165 21060326

4. Blecker S, Paul M, Taksler G, Ogedegbe G, Katz S. Heart Failure–Associated Hospitalizations in the United States. J Am Coll Cardiol. 2013;61: 1259–67. doi: 10.1016/j.jacc.2012.12.038 23500328

5. Daniłowicz-Szymanowicz L, Suchecka J, Niemirycz-Makurat A, Rozwadowska K, Raczak G. Autonomic Predictors of Hospitalization Due to Heart Failure Decompensation in Patients with Left Ventricular Systolic Dysfunction. PLOS ONE 2016;11: e0152372. doi: 10.1371/journal.pone.0152372 27015089

6. Tomaszuk-Kazberuk A, Bolińska S, Młodawska E, Łopatowska P, Sobkowicz B, Musiał W. Does admission anaemia still predict mortality six years after myocardial infarction? Kardiol Pol. 2014;72(6): 488–93. doi: 10.5603/KP.a2014.0046 24526561

7. Álvarez-García J, Ferrero-Gregori A, Puig T, Vázquez R, Delgado J, Pascual-Figal D, et al. A simple validated method for predicting the risk of hospitalization for worsening of heart failure in ambulatory patients: the Redin-SCORE. Eur J Heart Fail. 2015;17: 818–27. doi: 10.1002/ejhf.287 26011392

8. Ezekowitz J, O'Meara E, McDonald M, Abrams H, Chan M, Ducharme A et al. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol. 2017;33(11): 1342–1433. doi: 10.1016/j.cjca.2017.08.022 29111106

9. Testa G, Della-Morte D, Cacciatore F, Gargiulo G, D’Ambrosio D, Galizia G, et al. Precipitating Factors in Younger and Older Adults with Decompensated Chronic Heart Failure: Are They Different? J Am Geriatr Soc. 2013;61: 1827–8. 24117301

10. Gorcsan J, Tanaka H. Echocardiographic assessment of myocardial strain. J Am Coll Cardiol. 2011;58(14): 1401–13. doi: 10.1016/j.jacc.2011.06.038 21939821

11. Stanton T, Leano R, Marwick TH. Prediction of All-Cause Mortality From Global Longitudinal Speckle Strain. Circ Cardiovasc Imaging. 2009;2: 356–64. doi: 10.1161/CIRCIMAGING.109.862334 19808623

12. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, et al. Current and Evolving Echocardiographic Techniques for the Quantitative Evaluation of Cardiac Mechanics: ASE/EAE Consensus Statement on Methodology and Indications. J Am Soc Echocardiogr. 2011; 24:277–313. doi: 10.1016/j.echo.2011.01.015 21338865

13. Bertini M, Ng ACT, Antoni ML, Nucifora G, Ewe SH, Auger D, et al. Global Longitudinal Strain Predicts Long-Term Survival in Patients With Chronic Ischemic Cardiomyopathy. Circ Cardiovasc Imaging. 2012;5: 383–91. doi: 10.1161/CIRCIMAGING.111.970434 22412068

14. Saito M, Okayama H, Yoshii T, Higashi H, Morioka H, Hiasa G, et al. Clinical significance of global two-dimensional strain as a surrogate parameter of myocardial fibrosis and cardiac events in patients with hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2012;13: 617–23. doi: 10.1093/ejechocard/jer318 22271116

15. Ersbøll M, Valeur N, Mogensen UM, Andersen MJ, Møller JE, Hassager C, et al. Relationship between Left Ventricular Longitudinal Deformation and Clinical Heart Failure during Admission for Acute Myocardial Infarction: A Two-Dimensional Speckle-Tracking Study. J Am Soc Echocardiog. 2012;25: 1280–9. doi: 10.1016/j.echo.2012.09.006 23072712

16. Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100: 1673–80. doi: 10.1136/heartjnl-2014-305538 24860005

17. Sengeløv M, Jørgensen PG, Jensen JS, Bruun NE, Olsen FJ, Fritz-Hansen T, et al. Global Longitudinal Strain Is a Superior Predictor of All-Cause Mortality in Heart Failure With Reduced Ejection Fraction. JACC Cardiovasc Imaging. 2015;8: 1351–9. doi: 10.1016/j.jcmg.2015.07.013 26577264

18. Park JJ, Park J-B, Park J-H, Cho G-Y. Global Longitudinal Strain to Predict Mortality in Patients With Acute Heart Failure. J Am Coll Cardiol. 2018;71: 1947–57. doi: 10.1016/j.jacc.2018.02.064 29724346

19. Zhang KW, French B, May Khan A, Plappert T, Fang JC, Sweitzer NK, et al. Strain Improves Risk Prediction Beyond Ejection Fraction in Chronic Systolic Heart Failure. J Am Heart Assoc. 2014;3. doi: 10.1161/jaha.113.000550 24419736

20. Fox K, Garcia M, Ardissino D, Buszman P, Camici PG, Crea F, et al. Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006;27: 1341–1381. doi: 10.1093/eurheartj/ehl001 16735367

21. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJV, Ponikowski P, Poole-Wilson PA, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008‡. Eur J Heart Fail. 2008;10: 933–89. doi: 10.1016/j.ejheart.2008.08.005 18826876

22. McMurray JJV, Adamopoulos S, Anker SD, Auricchio A, Bohm M, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012;33: 1787–847. doi: 10.1093/eurheartj/ehs104 22611136

23. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016;37: 2129–200. doi: 10.1093/eurheartj/ehw128 27206819

24. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32: 1–64. doi: 10.1016/j.echo.2018.06.004 30282592

25. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28: 1–39.e14. doi: 10.1016/j.echo.2014.10.003 25559473

26. Leitman M, Lysiansky M, Lysyansky P, Friedman Z, Tyomkin V, Fuchs T, et al. Circumferential and Longitudinal Strain in 3 Myocardial Layers in Normal Subjects and in Patients with Regional Left Ventricular Dysfunction. J Am Soc Echocardiogr. 2010;23: 64–70. doi: 10.1016/j.echo.2009.10.004 20122496

27. Cho G-Y, Marwick TH, Kim H-S, Kim M-K, Hong K-S, Oh D-J. Global 2-Dimensional Strain as a New Prognosticator in Patients With Heart Failure. J Am Coll Cardiol. 2009;54: 618–24. doi: 10.1016/j.jacc.2009.04.061 19660692

28. Nahum J, Bensaid A, Dussault C, Macron L, Clémence D, Bouhemad B, et al. Impact of Longitudinal Myocardial Deformation on the Prognosis of Chronic Heart Failure Patients. Circ Cardiovasc Imaging. 2010;3: 249–56. doi: 10.1161/CIRCIMAGING.109.910893 20233858

29. Buggey J, Alenezi F, Yoon HJ, Phelan M, DeVore AD, Khouri MG, et al. Left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: outcomes following an acute heart failure hospitalization. ESC Heart Fail. 2017;4: 432–9. doi: 10.1002/ehf2.12159 29154416

30. Iacoviello M, Puzzovivo A, Guida P, Forleo C, Monitillo F, Catanzaro R, et al. Independent Role of Left Ventricular Global Longitudinal Strain in Predicting Prognosis of Chronic Heart Failure Patients. Echocardiography. 2013;30: 803–11. doi: 10.1111/echo.12142 23488596

31. Ersbøll M, Valeur N, Mogensen UM, Andersen MJ, Møller JE, Velazquez EJ, et al. Prediction of All-Cause Mortality and Heart Failure Admissions From Global Left Ventricular Longitudinal Strain in Patients With Acute Myocardial Infarction and Preserved Left Ventricular Ejection Fraction. J Am Coll Cardiol. 2013;61: 2365–73. doi: 10.1016/j.jacc.2013.02.061 23563128

32. Mignot A, Donal E, Zaroui A, Reant P, Salem A, Hamon C, et al. Global Longitudinal Strain as a Major Predictor of Cardiac Events in Patients with Depressed Left Ventricular Function: A Multicenter Study. J Am Soc Echocardiogr. 2010;23: 1019–24. doi: 10.1016/j.echo.2010.07.019 20810243

33. Kansal MM, Mansour IN, Ismail S, Bress A, Wu G, Mirza O, et al. Left ventricular global longitudinal strain predicts mortality and heart failure admissions in African American patients. Clin Cardiol. 2017;40: 314–21. doi: 10.1002/clc.22662 28272832

34. Motoki H, Borowski AG, Shrestha K, Troughton RW, Tang WHW, Thomas JD, et al. Incremental Prognostic Value of Assessing Left Ventricular Myocardial Mechanics in Patients With Chronic Systolic Heart Failure. J Am Coll Cardiol. 2012;60: 2074–81. doi: 10.1016/j.jacc.2012.07.047 23083779

35. Cacciatore F, Abete P, Mazzella F, Furgi G, Nicolino A, Longobardi G, et al. Six-minute walking test but not ejection fraction predicts mortality in elderly patients undergoing cardiac rehabilitation following coronary artery bypass grafting. Eur J Prev Cardiol. 2012;19(6): 1401–9. doi: 10.1177/1741826711422991 21933832

36. Hung C-L, Verma A, Uno H, Shin S-H, Bourgoun M, Hassanein AH, et al. Longitudinal and Circumferential Strain Rate, Left Ventricular Remodeling, and Prognosis After Myocardial Infarction. J Am Coll Cardiol. 2010;56: 1812–22. doi: 10.1016/j.jacc.2010.06.044 21087709

37. Risum N, Ali S, Olsen NT, Jons C, Khouri MG, Lauridsen TK, et al. Variability of Global Left Ventricular Deformation Analysis Using Vendor Dependent and Independent Two-Dimensional Speckle-Tracking Software in Adults. J Am Soc Echocardiogr. 2012;25: 1195–203. doi: 10.1016/j.echo.2012.08.007 22981228

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