Left ventricular global longitudinal strain adds incremental value for risk prediction in unselected clinical patients

Background Deformation imaging has demonstrated incremental prognostic value compared to left ventricular ejection fraction (LVEF) in specific cardiovascular diseases; however, it remains widely underused. Consequently, we sought to investigate the significance of deformation imaging in an all-comers population to assess its value in a routine in- and outpatient setting. Methods Patients were prospectively recruited to the single-centre cardiac magnetic resonance registry. Volumetric right and left ventricular (RV/LV) analyses and global circumferential strain were assessed on short-axis stacks, RV and LV global longitudinal strain (GLS) on long-axis views respectively. Follow-up was conducted for primary (all-cause mortality and heart failure hospitalisation) and secondary (all-cause mortality, hospitalised angina, infarction, and stroke) endpoints. Results In total, n=1655 patients met n=68 primary and n=107 secondary endpoints during a median follow-up of 399 days. GLS (HR 1.12, 95%CI 1.04-1.21 p=0.002; HR 1.10, 95%CI 1.03-1.16 p=0.002) but not LVEF (p=0.406; 0.209) was an independent predictor for the primary and secondary endpoint. GLS was an independent predictor for the primary endpoint after correction for commonly considered risk factors including, age, NYHA class, tissue characterisation native T1, biomarker NT-proBNP, and glomerular filtration rate (HR 1.09, 95%CI 1.03-1.15, p=0.003). After dichotomisation at the median of -16.4%, GLS added incremental value to risk stratification for the primary endpoint on Kaplan-Meier plots in patients with LVEF above (p=0.045) and below (p=0.017) the median of 55%. Conclusion In an all-comers, low-risk patient population, GLS emerged as an independent risk predictor with incremental prognostic value relative to LVEF. This finding may support clinical routine implementation of GLS in cardiac in- and outpatient clinics.