title: Global longitudinal strain as a potential prognostic marker in patients with chronic heart failure and systolic dysfunction.
abstract: OBJECTIVE
  The prognostic value of myocardium deformation measurements in chronic heart failure (CHF) is still poorly addressed. The purpose of this study was to evaluate the correlation of left ventricular (LV) global longitudinal strain (GLS) with clinical and prognostic indicators in patients with CHF and systolic dysfunction.
  
  
  METHODS
  Ambulatory patients with CHF and LV ejection fraction (LVEF) <45% were studied by two-dimensional and Doppler transthoracic echocardiogram with assessment of GLS. An indication of prognostic status was obtained by the Seattle Heart Failure Model (SHFM) prognostic estimates for life expectancy.
  
  
  RESULTS
  We included 54 CHF patients (mean age 55±12 years; 80% male). GLS was significantly correlated with NYHA functional class (r=0.41, p=0.002), BNP levels (r=0.47, p=0.001), LVEF (r=-0.69, p<0.001) and LV end-diastolic pressure, assessed by E/e' ratio (r=0.35, p<0.014) and left atrial maximal volume index (r=0.57, p<0.001). A significant correlation was found between GLS and SHFM prognostic estimates for life expectancy (r=-0.41, p=0.002). The multivariate logistic regression analysis showed that GLS independently predicted an estimated life expectancy <10 years (OR 2.614 [95% CI 1.010-6.763]). The corresponding area under the ROC curve was 0.802 (0.653-0.951) and the best obtained threshold was -9.5 (80% sensitivity, 65% specificity, p=0.003).
  
  
  CONCLUSIONS
  GLS was strongly associated with a higher disease severity status and predicted a lower prognostic estimate for life expectancy.
authors.affiliation: Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal. Electronic address: inesrang@gmail.com.
authors.forename: Inês
authors.initials: I
authors.lastname: Rangel
authors.affiliation: Faculty of Medicine of Porto University, Porto, Portugal.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.affiliation: Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: de Sousa
authors.affiliation: Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.
authors.forename: Pedro Bernardo
authors.initials: PB
authors.lastname: Almeida
authors.affiliation: Faculty of Medicine of Porto University, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Rodrigues
authors.affiliation: Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.
authors.forename: Filipe
authors.initials: F
authors.lastname: Macedo
authors.affiliation: Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Silva Cardoso
authors.affiliation: Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal.
authors.forename: Ma Júlia
authors.initials: MJ
authors.lastname: Maciel
mesh_terms: D001696:Biomechanical Phenomena; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology*
keywords: Heart failure; Insuficiência cardíaca; Longitudinal strain; Prognosis; Prognóstico; Strain longitudinal global