May 11, 2026Journal of the American College of Cardiology
Global Longitudinal Strain to Predict Mortality in Patients With Acute Heart Failure
Key result
Severely reduced GLS is linked to ~61% higher 5-year mortality in acute heart failure.
- HR 1.61
- 95% CI 1.36 to 1.91
- P<0.001
- n=4,172
Why the study?
The prognostic value of left ventricular ejection fraction (LVEF) in heart failure is controversial, and myocardial strain may provide independent prognostic information.
Does global longitudinal strain (GLS) measurement improve prognostic prediction of 5-year all-cause mortality compared to LVEF in patients with acute heart failure?
Population
4,172 consecutive patients with acute heart failure
Comparison
Global longitudinal strain (GLS) vs left ventricular ejection fraction (LVEF)
Design
Observational cohort study
Follow-up
5 years
Authors
Discussion
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Implication
Global longitudinal strain provides superior prognostic value for 5-year mortality compared to left ventricular ejection fraction in patients with acute heart failure.
Key Points
- Evaluate the prognostic capacity of global longitudinal strain compared with left ventricular ejection fraction for predicting long-term mortality in patients with acute heart failure.
- Measured global longitudinal strain (GLS) in 4,172 consecutive patients with acute heart failure categorized by ejection fraction (reduced <40%, midrange 40%–49%, preserved ≥50%) and strain severity (mildly >12.6%, moderately 8.1%–12.5%, severely ≤8.0%).
- Tracked 5-year all-cause mortality as the primary endpoint and performed multivariable survival analyses adjusting for left ventricular ejection fraction and clinical covariates.
- Five-year all-cause mortality reached 40.4% (1,740 deaths), demonstrating sharper stratification by GLS severity (mild 34%, moderate 38%, severe 49%; log-rank p < 0.001) than by ejection fraction (preserved 39%, midrange 38%, reduced 41%; log-rank p = 0.031).
- In multivariable analysis, each 1% increase in GLS conferred a 5% reduction in mortality risk (p < 0.001), with elevated mortality for moderate (HR: 1.31; 95% CI: 1.13 to 1.53) and severe reductions (HR: 1.61; 95% CI: 1.36 to 1.91), while ejection fraction showed no independent association.
Study Design
Type
Cohort (n=4,172)
Structured PICO
Does global longitudinal strain (GLS) measurement improve prognostic prediction of 5-year all-cause mortality compared to LVEF in patients with acute heart failure?
P
Population
4,172 consecutive patients with acute heart failure followed for 5 years to evaluate the prognostic value of global longitudinal strain.
E
Exposure
Global longitudinal strain (GLS) measurement
C
Comparator
Left ventricular ejection fraction (LVEF) measurement
O
Outcome
5-year all-cause mortalityhard clinical
Main Result
Hazard Ratio: 1.61 (95% CI 1.36–1.91)
Absolute Event Rate: 49% vs 34%
p-value: p=< 0.001
Global longitudinal strain provides superior prognostic value for 5-year mortality compared to left ventricular ejection fraction in patients with acute heart failure.
Cite This Study
Park et al. (2018) conducted a cohort in Acute heart failure (n=4,172). Severely reduced global longitudinal strain (GLS ≤8.0%) vs. Mildly reduced strain (GLS >12.6%) was evaluated on 5-year all-cause mortality (HR 1.61, 95% CI 1.36 to 1.91, p=< 0.001). Severely reduced global longitudinal strain was associated with higher 5-year mortality compared to mildly reduced strain in patients with acute heart failure (HR 1.61; 95% CI 1.36-1.91; P<0.001).