title: Global left ventricular longitudinal systolic strain as a major predictor of cardiovascular events in patients with atrial fibrillation.
abstract: OBJECTIVE
  Although global left ventricular longitudinal systolic strain (GLS) is a sensitive measure of left ventricular mechanics, its relationship with adverse cardiovascular (CV) events in atrial fibrillation (AF) has not been evaluated. This study sought to examine the ability of GLS in predicting CV events in AF.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Department of cardiology in a university hospital.
  
  
  METHODS
  196 persistent AF patients referred for echocardiographic examination.
  
  
  METHODS
  The risk of GLS measured by index beat method for CV events was assessed by Cox proportional hazards analyses. CV events were defined as CV death, non-fatal stroke and hospitalisation for heart failure.
  
  
  RESULTS
  There were 19 CV deaths, 12 non-fatal stroke and 28 hospitalisations for heart failure during an average follow-up of 21 ± 10 months. Multivariate analysis showed worsening GLS (HR 1.121; 95% CI 1.023 to 1.228, p=0.014) was independently associated with increased CV events. In direct comparison, GLS outperformed left ventricular ejection fraction (LVEF) and systolic mitral annulus velocity (Sa) in predicting adverse CV events both in univariate and multivariate models (p ≤ 0.043). Besides, the addition of GLS to a Cox model containing chronic heart failure, hypertension, age ≥ 75 years, diabetes, prior stroke score, estimated glomerular filtration rate, LVEF and Sa provided an additional benefit in the prediction of adverse CV events (p=0.022).
  
  
  CONCLUSIONS
  GLS was a major parameter and stronger than LVEF and Sa in predicting adverse CV events and could offer an additional prognostic benefit over conventional clinical and echocardiographic systolic parameters in AF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, , Kaohsiung, Taiwan.
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.forename: Po-Chao
authors.initials: PC
authors.lastname: Hsu
authors.forename: Wen-Hsien
authors.initials: WH
authors.lastname: Lee
authors.forename: Chun-Yuan
authors.initials: CY
authors.lastname: Chu
authors.forename: Chee-Siong
authors.initials: CS
authors.lastname: Lee
authors.forename: Wen-Chol
authors.initials: WC
authors.lastname: Voon
authors.forename: Wen-Ter
authors.initials: WT
authors.lastname: Lai
authors.forename: Sheng-Hsiung
authors.initials: SH
authors.lastname: Sheu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013599:Systole; D016277:Ventricular Function, Left