title: Global longitudinal strain is associated with heart failure outcomes in hypertrophic cardiomyopathy.
abstract: We hypothesised that abnormal global longitudinal strain (GLS) would predict outcome in hypertrophic cardiomyopathy (HCM) better than current echocardiographic measures.
  
  
  
  Retrospective analysis of risk markers in relation to outcomes in 472 patients with HCM at a single tertiary institution (2006-2012). Exclusion criteria were left ventricular (LV) hypertrophy of other origin, patients in atrial fibrillation, lost to follow-up and insufficient image quality to perform strain analysis. Standardised echocardiogram recordings were reviewed and standard variables and LV GLS were measured. The primary end-point included all cardiac deaths, appropriate defibrillator shocks and heart failure (HF) admissions. The secondary end-point was death by HF and admissions related to HF.
  
  
  
  Mean age was 50.0±15.0 years; 322 (68%) were men. At a median of 4.3 years (IQR 0.1-7.8) follow-up, 21 (4.4%) patients experienced cardiovascular death: 6 (1.3%) died from HF, 13 (2.7%) had sudden cardiac death and 2 (0.4%) died secondary to stroke. Four (0.8%) patients experienced appropriate defibrillator shock, and 13 (2.7%) were admitted for HF. On multivariate Fine-Gray proportional hazard analyses, GLS was significantly associated with the primary end-point (HR=0.90, 95% CI 0.83 to 0.98, p=0.018) independently of age, maximal provoked LV outflow-tract gradient and LV end-systolic volume. Moreover, GLS was particularly associated with the secondary end-point (HR=0.82, 95% CI 0.75 to 0.90, p<0.0001) independently of age, previous atrial fibrillation, New York Heart Association (NYHA) class III-IV, LV end-systolic volume, E/E', and outflow-tract gradient. Survival curves confirmed that GLS was associated with HF events (GLS <15.6%, p=0.0035).
  
  
  
  In patients with HCM, reduced GLS is an independent factor associated with poor cardiac outcomes, and particularly HF outcomes.
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK University of Bordeaux, CHU de Bordeaux, Bordeaux, France.
authors: Patricia
authors: P
authors: Reant
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
authors: Mariana
authors: M
authors: Mirabel
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Guy
authors: G
authors: Lloyd
authors: University of Bordeaux, CHU de Bordeaux, Bordeaux, France.
authors: Jérôme
authors: J
authors: Peyrou
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Jose-Maria
authors: JM
authors: Lopez Ayala
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Shaughan
authors: S
authors: Dickie
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Heeraj
authors: H
authors: Bulluck
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Gabriella
authors: G
authors: Captur
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Stefania
authors: S
authors: Rosmini
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Oliver
authors: O
authors: Guttmann
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Camelia
authors: C
authors: Demetrescu
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Antonis
authors: A
authors: Pantazis
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: Maite
authors: M
authors: Tome-Esteban
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: James C
authors: JC
authors: Moon
authors: University of Bordeaux, CHU de Bordeaux, Bordeaux, France.
authors: Stephane
authors: S
authors: Lafitte
authors: Inherited Cardiac Disease Unit, The Heart Hospital; Institute of Cardiovascular Science, University College London, London, UK.
authors: William J
authors: WJ
authors: McKenna
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D002423:Cause of Death; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013314:Stress, Mechanical; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D016277:Ventricular Function, Left