Global longitudinal strain: Ready for ‘prime time’ in heart failure characterization

Abstract

This article refers to 'Global longitudinal strain predicts clinical outcomes in patients with heart failure with preserved ejection fraction' by A. Brann et al., published in this issue on pages 1755-1765.Recent trials in patients with heart failure with preserved ejection fraction (HFpEF) suggest that heart failure, independently of left ventricular ejection fraction (LVEF), may take advantage of the same therapies. 1 These trials, together with new information coming from imaging studies, provide support to further discuss the initial concept that HF could be a single syndrome with different phenotypes. 2 These phenotypes must be characterized properly. The question is how can we push cardiac imaging, and especially echocardiography, to improve the phenotypic characterization of HF patients.In this issue, Brann et al. 3 report the results of a retrospective analysis from a cohort of 311 patients with HFpEF with a median follow-up of 4.6 years. Every patient had an initial echocardiogram, but also serial examinations. The aim was to evaluate the prognostic role of global longitudinal strain (GLS), but also if GLS could predict a deterioration in ejection fraction. The study inclusion criteria, and the definition of HFpEF, were similar to those used in the PARAGON-HF trial 4 and therefore it was not surprising that, as mentioned in the supplementary material, the clinical characteristics of their population were rather similar to other HFpEF trials and recent major registries in Europe and North America. 3 The results provide additional data justifying some enthusiasm in using speckle tracking echocardiography to improve the characterization of the HF population. Several previous studies have shown that GLS is really a need and an additive parameter to LVEF. 5 In Brann et al., 3 59% of the HFpEF population had an abnormal GLS (cut-off of 15.8%) despite a preserved ejection fraction. An important message, out of the risk of event associated with lowest value of GLS, comes from the 1.9-fold increased risk for LVEF deterioration. It highlights the underlying abnormal contractile function that has been observed in several context and promoted largely in the The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.