title: Left ventricular global longitudinal strain predicts mortality and heart failure admissions in African American patients.
abstract: BACKGROUND
  Several studies have demonstrated the importance of left ventricular (LV) global longitudinal strain (GLS) as a reliable prognostic indicator in patients with heart failure (HF). These studies have included few African American (AA) patients, despite the growing prevalence and severity of HF in this patient population.
  
  
  OBJECTIVE
  LV GLS predicts long-term HF admission and all-cause mortality in AA patients with chronic HF on optimal guideline-directed medical therapy (GDMT).
  
  
  METHODS
  We enrolled 207 AA adults, age 56 ± 14.5 years, with New York Heart Association (NYHA) class I through III HF on optimal GDMT from the University of Illinois HF clinic between November 2001 and February 2014. LV GLS was assessed by velocity vector imaging using 2-, 3-, and 4-chamber views. Patients were followed for HF admissions and death for 3 ± 3.0 years. LV GLS value of -7.95 was used as the optimal cutoff point that maximizes sensitivity and specificity RESULTS: LV GLS < -7.95% was significantly associated with higher all-cause mortality and HF admissions in Kaplan-Meier survival curves (log-rank P < 0.001). After incorporation in multivariate Cox proportional hazard models, GLS < -7.95% was found to be an independent predictor of all-cause mortality (hazard ratio [HR] = 4.04; 95% confidence interval [CI]: 1.07-15.32; P = 0.04] and HF admissions (HR = 3.86; 95% CI: 1.38-10.77; P = 0.010).
  
  
  CONCLUSIONS
  In AA patients with chronic stable HF on GDMT, more impaired LV GLS (< -7.95%) is a strong and independent predictor of long-term all-cause mortality and HF admissions.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Mayank M
authors.identifier: http://orcid.org/0000-0003-2552-8744
authors.initials: MM
authors.lastname: Kansal
authors.affiliation: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Ibrahim N
authors.initials: IN
authors.lastname: Mansour
authors.affiliation: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Sahar
authors.initials: S
authors.lastname: Ismail
authors.affiliation: Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Adam
authors.initials: A
authors.lastname: Bress
authors.affiliation: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Grace
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Omer
authors.initials: O
authors.lastname: Mirza
authors.affiliation: Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Rahul
authors.initials: R
authors.lastname: Marpadga
authors.affiliation: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Hana
authors.initials: H
authors.lastname: Gheith
authors.affiliation: Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Yoonsang
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Yien
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Larisa
authors.initials: L
authors.lastname: Cavallari
authors.affiliation: Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stamos
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001696:Biomechanical Phenomena; D002423:Cause of Death; D016009:Chi-Square Distribution; D002641:Chicago; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology*; D016277:Ventricular Function, Left
keywords: African Americans; Heart failure/cardiac transplantation/cardiomyopathy/myocarditis; Mortality; Readmission; Speckle-tracking Strain