Association of Global Longitudinal Strain and Long‐Term Transplant‐Free Survival in Fontan Patients

Background and Objectives Patients with single‐ventricle physiology undergoing Fontan operations face high morbidity and mortality risks. While classic‐pattern dyssynchrony (CPD) and protein‐losing enteropathy (PLE) are known predictors of adverse outcomes, the role of global longitudinal strain (GLS) as an independent predictor of heart failure remains unclear. Methods A retrospective cohort study of 135 Fontan‐operated patients from 2014 to 2015 evaluated the predictive value of GLS alongside PLE and CPD on mortality and transplantation after 9 years. Echocardiographic data, including GLS, were analyzed using speckle tracking strain analysis in 132 patients. The primary endpoint was transplant‐free survival. Results Among 132 Fontan patients, 15 had classic‐pattern dyssynchrony, 29 had protein‐losing enteropathy, 37 had moderately reduced global longitudinal strain (GLS ←8% ≥–16%), and 18 had severely reduced GLS (≥–8%). Cox regression analysis showed moderately reduced GLS increased mortality risk (HR 5.8, 95% CI 1.27–26.5, p = 0.023), with severely reduced GLS showing an HR of 10.3 (95% CI 2.18–48.6, p = 0.003). These results were comparable to CPD (HR 11.5, p = 0.002) and PLE (HR 14.9, p < 0.001). Conclusion Global longitudinal strain emerged as the best independent factor for predicting long‐term transplant‐free survival in Fontan patients, highlighting the importance of GLS assessment in routine follow‐up to identify high‐risk individuals for early intervention.