Table 5.

Association of LV global longitudinal systolic strain (GLS) with outcomes in HFpEF

Study	Primary end point	Events (n)	Dichotomous univariate analysis Abnormal GLS HR (95% CI)	Dichotomous multivariate analysis Abnormal GLS HR (95% CI)	Continuous univariate analysis  GLS 1SD or 1% decrease HR (95% CI)	Continuous multivariate analysis GLS 1SD or 1% decrease HR (95% CI)
Shah et al15	CV death or aborted cardiac arrest or HF hospitalisation	115	2.26 (1.53 to 3.34)	2.14 (1.26 to 3.66)	1.13 (1.08 to 1.19)	1.14 (1.04 to 1.24)
Donal et al19 20*	All-cause death or HF hospitalisation	177	not reported	1.94 (1.22 to 3.07)	not reported	not reported
Huang et al24	All-cause death	27	3.4 (1.02 to 11.3)	4.72 (1.25 to 17.8)	not reported	not reported
Pellicori et al29	CV death or HF hospitalisation	62	not reported	not reported	1.09 (1.00 to 1.19)	0.99 (0.90 to 1.11)
Freed et al31	All-cause death or CV hospitalisation	115	not reported	not reported	1.25 (1.03 to 1.52)	1.17 (0.95 to 1.43)
Obokata et al32	CV death, non-fatal MI and HF exacerbation	29	not reported	not reported	0.99 (0.87 to 1.13)	not reported
Stampehl et al14†	CV death or HF hospitalisation	17	not reported	not reported	not reported	not reported
Wang et al30‡	All-cause death or HF hospitalisation	43	not reported	not reported	not reported	not reported
DeVore et al33§	All-cause death or all-cause hospitalisation	35	not reported	not reported	not reported	not reported

*Donal et al did not find a significant link between GLS and CV outcomes at 28 months in a continuous Cox proportional hazards regression analysis in 356 patients (univariate analysis: p =0.1406; multivariate analysis: p =0.1192; the HR of this analysis was not reported).¹⁹ However, in a post hoc analysis of these data in 348 patients,²⁰ an abnormal GLS (<16% in absolute values) was significantly linked to the combined end point of total mortality or HF hospitalisation at 18 months (HR 1.94 (1.22–3.07)), but an abnormal GLS was not linked to mortality-only at 18 months (HR 1.56 (0.84–2.89)).

†Stampehl et al found in a dichotomous univariate Cox proportional hazards regression analysis that an abnormal GLS (< 15% in absolute values) was linked to worse CV outcomes (Χ²=4.0, p=0.04; the HR of this analysis was not reported). In addition, patients with events had significantly lower GLS than those without events (−11.6 ± 0.4% vs −16.5 ± 0.5%, p=0.03).¹⁴

‡Wang et al did not find a significant link in a continuous logistic regression analysis between GLS at rest and CV outcomes (the HR of this analysis was not reported). In line, patients with events had similar values of GLS at rest than those without events (−17.5 ± 3.7% vs −18.8 ± 2.9%, p > 0.05). However, GLS during exercise was significantly linked to CV outcomes (univariate analysis: HR 0.81 (0.72–0.92), p < 0.01; multivariate analysis: HR 0.79 (0.67–0.91), p < 0.01) in a continuous logistic regression analysis. In addition, patients with events had significantly lower GLS during exercise than those without events (−18.2 ± 3.9% vs −21.4 ± 3.9%; p=0.001).³⁰

§DeVore et al did not find a significant link between the tertiles of GLS and a composite end point of time to death or all-cause hospitalisation (p=0.952).³³

CV, cardiovascular; GLS, global longitudinal systolic strain (ie, average longitudinal peak systolic strain from ≥12 LV segments); HF, heart failure; HFpEF, heart failure with preserved ejection fraction; MI, myocardial infarction.