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. 2021 Oct;8(5):4343-4345.
doi: 10.1002/ehf2.13465. Epub 2021 Jul 17.

A global longitudinal strain cut-off value to predict adverse outcomes in individuals with a normal ejection fraction

Job A J Verdonschot  1   2 , Michiel T H M Henkens  2 , Ping Wang  1 , Georg Schummers  3 , Anne G Raafs  2 , Ingrid P C Krapels  1 , Vanessa van Empel  2 , Stephane R B Heymans  2   4 , Hans-Peter Brunner-La Rocca  2 , Christian Knackstedt  2
Affiliations

A global longitudinal strain cut-off value to predict adverse outcomes in individuals with a normal ejection fraction

Job A J Verdonschot et al. ESC Heart Fail. 2021 Oct.

Abstract

Aims: Global longitudinal strain (GLS) has become an alternative to left ventricular ejection fraction (LVEF) to determine systolic function of the heart. The absence of cut-off values is one of the limitations preventing full clinical implementation. The aim of this study is to determine a cut-off value of GLS for an increased risk of adverse events in individuals with a normal LVEF.

Methods and results: Echocardiographic images of 502 subjects (52% female, mean age 48 ± 15) with an LVEF ≥ 55% were analysed using speckle tracking-based GLS. The primary endpoint was cardiovascular death or cardiac hospitalization. The analysis of Cox models with splines was performed to visualize the effect of GLS on outcome. A cut-off value was suggested by determining the optimal specificity and sensitivity. The median GLS was -22.2% (inter-quartile range -20.0 to -24.9%). In total, 35 subjects (7%) had a cardiac hospitalization and/or died because of cardiovascular disease during a follow-up of 40 (5-80) months. There was a linear correlation between the risk for adverse events and GLS value. Subjects with a normal LVEF and a GLS between -22.9% and -20.9% had a mildly increased risk (hazard ratio 1.01-2.0) for cardiac hospitalization or cardiovascular mortality, and the risk was doubled for subjects with a GLS of -20.9% and higher. The optimal specificity and sensitivity were determined at a GLS value of -20.0% (hazard ratio 2.49; 95% confidence interval: 1.71-3.61).

Conclusions: There is a strong correlation between cardiac adverse events and GLS values in subjects with a normal LVEF. In our single-centre study, -20.0% was determined as a cut-off value to identify subjects at risk. A next step should be to integrate GLS values in a multi-parametric model.

Keywords: Echocardiography; Global longitudinal strain; Healthy; Prognosis.

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Conflict of interest statement

G.S. is employed at TOMTEC Imaging Systems GmbH. C.K. has received research support (software and hardware) from TOMTEC Imaging Systems.

Figures

Figure 1
Figure 1
Hazard ratio plotted against global longitudinal strain (GLS) value. The lowest risk in the study population was associated with a GLS value of −26.7 (black line). The hazard ratio is expressed using this point as the reference. Patients with a GLS of −22.9 (orange line) had a significant higher risk, and patients with a value of −20.9 (red line) had a double risk for adverse events compared with subjects with a GLS value of −26.7. The blue line and range indicate the hazard ratio with the 95% confidence interval. Lines on the x‐axis represent individual study subjects. Adverse events are defined as cardiovascular death and/or cardiac hospitalization.
See this image and copyright information in PMC

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