Clinical Usefulness of Left Ventricular Global Longitudinal Strain as a Predictor of Prognosis in Patients With Acute Ischemic Stroke (GLS‐STROKE Study)

Background The prognostic role of left ventricular global longitudinal strain (LV‐GLS) in acute ischemic stroke (AIS) remains unexplored despite its established value in cardiovascular conditions. We aimed to investigate the prognostic value of LV‐GLS in patients with AIS. Methods In this prospective cohort study, 698 patients with AIS (mean age, 67.6±13.8 years; 60.2% men) underwent transthoracic echocardiography using speckle‐tracking to measure LV‐GLS within 7 days of admission. The primary end points included all‐cause death and recurrent ischemic stroke, with a 3‐month modified Rankin Scale score ≥3 considered a poor outcome. Results Over a median follow‐up of 593 days, the primary end point occurred in 65 patients (9.3%), with significant differences in LV‐GLS between those reaching the end point (16.3%) and the others (19.1%; P <0.001). Cox regression demonstrated LV‐GLS as a statistically significant predictor of outcomes (adjusted hazard ratio, 0.81 95% CI, 0.74–0.89; P <0.001). Additional analyses showed that LV‐GLS enhanced predictive performance for the primary end point, indicated by improvements in global χ 2 and continuous net reclassification index analyses (0.25 95% CI, 0.01–0.42; P =0.044). Subgroup analysis revealed the prognostic relevance of LV‐GLS irrespective of atrial fibrillation status. In predicting a poor functional outcome, LV‐GLS also provided incremental value over traditional risk factors and the initial National Institutes of Health Stroke Scale score (continuous net reclassification index, 0.27 95% CI, 0.09–0.45; P =0.004). Conclusions LV‐GLS is a robust predictor of cardiocerebrovascular outcomes in AIS and offers incremental prognostic value beyond traditional risk factors. Incorporating LV‐GLS into AIS management may help identify high‐risk patients and guide intensive monitoring strategies. Registration URL: https://trialsearch.who.int . Unique identifier: KCT0005780.