title: Global longitudinal strain predicts long-term survival in patients with chronic ischemic cardiomyopathy.
abstract: BACKGROUND
  Left ventricular (LV) global longitudinal strain (GLS) is a measure of the active shortening of the LV in the longitudinal direction, which can be assessed with speckle-tracking echocardiography. The aims of this evaluation were to validate the prognostic value of GLS as a new index of LV systolic function in a large cohort of patients with chronic ischemic cardiomyopathy and to determine the incremental value of GLS to predict long-term outcome over other strong and well-established prognostic factors.
  
  
  RESULTS
  A total of 1060 patients underwent baseline clinical evaluation and transthoracic echocardiography. Median age was 66.9 years (interquartile range, 58.4, 74.2 years); 739 (70%) were men. The median follow-up duration for the entire patient population was 31 months. During the follow-up, 270 patients died and 309 patients reached the combined end point (all-cause mortality and heart failure hospitalization). Compared with survivors, patients who died (270, [25%]) had larger LV volumes (P<0.05), lower LV ejection fraction (P=0.004), higher wall motion score index (P=0.001), and greater impairment of LV GLS (P<0.001). After dichotomizing the population on the basis of the median value of LV GLS (-11.5%), patients with an LV GLS ≤-11.5% had superior outcome compared with patients with an LV GLS >-11.5% (log-rank χ(2), 13.86 and 14.16 for all-cause mortality and combined end point, respectively, P<0.001 for both). On multivariate analysis, GLS was independently related to all-cause mortality (hazard ratio per 5% increase, 1.69; 95% confidence interval, 1.33-2.15; P<0.001) and combined end point (1.64; 95% confidence interval, 1.32-2.04; P<0.001).
  
  
  CONCLUSIONS
  The assessment of LV GLS with speckle-tracking echocardiography is significantly related to long-term outcome in patients with chronic ischemic cardiomyopathy.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bertini
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: M Louisa
authors.initials: ML
authors.lastname: Antoni
authors.forename: Gaetano
authors.initials: G
authors.lastname: Nucifora
authors.forename: See H
authors.initials: SH
authors.lastname: Ewe
authors.forename: Dominique
authors.initials: D
authors.lastname: Auger
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D016019:Survival Analysis; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*