Prognostic value of global longitudinal strain in patients with preserved left ventricular systolic function: A cardiac magnetic resonance real-world study

Fig. 1. Representative FT-CMR images of (A) normal LV-GLS (LV-GLS <−14.4) and (B) abnormal LV-GLS (LV-GLS ≥−14.4). Upper left 3 images = 2-chamber view; upper right graph = LV-GLS graph corresponding to the (A) images; lower left 3 images = 4-chamber view; and lower right graph = LV-GLS graph corresponding to the (B) images. FT-CMR: feature tracking-cardiac magnetic resonance, LV-GLS left ventricular global longitudinal strain.

Fig. 2. Flow diagram describing patient enrollment and the flow of patients in this study. FT-CMR feature tracking-cardiovascular magnetic resonance, LVEF left ventricular ejection fraction, LV-GLS left ventricular global longitudinal strain.

Fig. 3. The incidence per 100 person-years for the composite outcome and for each of the component outcomes of the composite outcome compared between the LV-GLS <−14.4% and ≥−14.4% groups. A p-value <0.05 indicates statistical significance. ACS acute coronary syndrome, LV-GLS left ventricular global longitudinal strain, MI myocardial infarction.

Fig. 4. Kaplan-Meier survival analysis of the composite outcome compared between LV-GLS <−14.4% and LV-GLS ≥−14.4% (A), presence of LGE (B), and combined LV-GLS and LGE data (C). LGE late gadolinium enhancement, LV-GLS left ventricular global longitudinal strain.

Fig. 5. Incremental prognostic value shown as global chi-squared value using cardiovascular risk factors, risk factors plus LVEF, risk factors plus LVEF and LGE, and risk factors plus LVEF, LGE, and LV-GLS patients. LVEF left ventricular ejection fraction, LV-GLS left ventricular global longitudinal strain, LGE late gadolinium enhancement, ECVextracellular volume, GLS global longitudinal strain.

Fig. 6. Restricted cubic spline plots show the hazard ratios (with 95%CIs) for the occurrence of a composite outcome event according to A) LV-GLS and B) LVEF. The gray horizontal dashed line indicates a hazard ratio of 1. Data distributions are represented by the pink (LV-GLS) and blue (LVEF) shaded areas. CI confidence interval, LVEF left ventricular ejection fraction, LV-GLS left ventricular global longitudinal strain, LGE late gadolinium enhancement.

Fig. 7. Variables in the final step of the Cox regression models (A) using LV LGS ROC cutoff (−14.4%), (B) using AHA recommendation cutoff (−16%), and (C) using median of the LV-GLS (−14.9%) as the cutoff. LV-GLS: left ventricular global longitudinal strain, ROC: receiver operating characteristics, HR: hazard ratio, CI: confidence interval, BMI: body mass index, LVEF: left ventricular ejection fraction, LGE: late gadolinium enhancement, AHA: American Heart Association, SBP: systolic blood pressure.