GLS is an independent predictor of all-cause mortality in HFrEF patients, especially in male patients without AF. Furthermore, GLS was a superior prognosticator compared with all other echocardiographic parameters.

Background Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown. Method and Results A total of 1,296 participants in a general population study underwent a health examination including echocardiography measurement of GLS. The primary endpoint was the composite of incident heart failure (HF), acute myocardial infarction (AMI) or cardiovascular death (CVD). During a median follow-up of 11 years, 149 (12%) participants were diagnosed with HF, AMI or CVD. Lower GLS was associated with a higher risk of the composite endpoint (HR 1.12 [1.08–1.17], p<0.001 per 1% decrease), an association that persisted after multivariable adjustment for age, gender, heart rate, hypertension, systolic blood pressure, left ventricular (LV) ejection fraction, LV mass index, LV dimension, deceleration time, left atrium dimension, E/e′ and pro-BNP (HR 1.05 [1.00–1.11], p=0.045 per 1% decrease). GLS provided incremental prognostic information beyond the Framingham Risk Score, the SCORE risk chart and the modified ACC/AHA Pooled Cohort Equation for the composite outcome and incident HF. Gender modified the relationship between GLS and outcome such that after multivariable adjustment GLS was an independent predictor of outcomes in men but not women (HR 1.14 [1.06–1.24], p=0.001, and HR 0.99 [0.92–1.07], p=0.81 respectively; p for interaction=0.032). Conclusions In the general population, GLS provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality. GLS appears to be a stronger prognosticator in men than in women.