Prognostic Relevance of Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Reduced Ejection Fraction

Abstract

Patients with heart failure (HF) and reduced ejection fraction (HFrEF) are complex patients who often have a high prevalence of co-morbidities and risk factors. In the present study, we investigated the prognostic significance of left ventricular (LV) global longitudinal strain (GLS) along with important clinical and echocardiographic variables in patients with HFrEF. Patients who had a first echocardiographic diagnosis of LV systolic dysfunction, defined as LV ejection fraction ≤45%, were selected. The study population was subdivided into 2 groups based on a spline curve analysis derived optimal threshold value of LV GLS (≤10%). The primary end point was occurrence of worsening HF, whereas the composite of worsening HF and all-cause death was chosen for the secondary end point. A total of 1,873 patients (mean age 63 ± 12 years, 75% men) were analyzed. During a median follow-up of 60 months (interquartile range 27 to 60 months), 256 patients (14%) experienced worsening HF and the composite end point of worsening HF and all-cause mortality occurred in 573 patients (31%). The 5-year event-free survival rates for the primary and secondary end point were significantly lower in the LV GLS ≤10% group compared with the LV GLS >10% group. After adjustment for important clinical and echocardiographic variables, baseline LV GLS remained independently associated with a higher risk of worsening HF (hazard ratio 0.95, 95% confidence interval 0.90 to 0.99, p = 0.032) and the composite of worsening HF and all-cause mortality (hazard ratio 0.94, 95% confidence interval 0.90 to 0.97, p = 0.001). In conclusion, baseline LV GLS is associated with long-term prognosis in patients with HFrEF, independent of various clinical and echocardiographic predictors. Patients with heart failure (HF) and reduced ejection fraction (HFrEF) are complex patients who often have a high prevalence of co-morbidities and risk factors. In the present study, we investigated the prognostic significance of left ventricular (LV) global longitudinal strain (GLS) along with important clinical and echocardiographic variables in patients with HFrEF. Patients who had a first echocardiographic diagnosis of LV systolic dysfunction, defined as LV ejection fraction ≤45%, were selected. The study population was subdivided into 2 groups based on a spline curve analysis derived optimal threshold value of LV GLS (≤10%). The primary end point was occurrence of worsening HF, whereas the composite of worsening HF and all-cause death was chosen for the secondary end point. A total of 1,873 patients (mean age 63 ± 12 years, 75% men) were analyzed. During a median follow-up of 60 months (interquartile range 27 to 60 months), 256 patients (14%) experienced worsening HF and the composite end point of worsening HF and all-cause mortality occurred in 573 patients (31%). The 5-year event-free survival rates for the primary and secondary end point were significantly lower in the LV GLS ≤10% group compared with the LV GLS >10% group. After adjustment for important clinical and echocardiographic variables, baseline LV GLS remained independently associated with a higher risk of worsening HF (hazard ratio 0.95, 95% confidence interval 0.90 to 0.99, p = 0.032) and the composite of worsening HF and all-cause mortality (hazard ratio 0.94, 95% confidence interval 0.90 to 0.97, p = 0.001). In conclusion, baseline LV GLS is associated with long-term prognosis in patients with HFrEF, independent of various clinical and echocardiographic predictors. Heart failure (HF) with reduced ejection fraction (HFrEF) is the most common type of HF and is associated with a poor prognosis, even when being compared with other types of HF including HF with midrange or preserved ejection fraction (EF).1Chioncel O Lainscak M Seferovic PM Anker SD Crespo-Leiro MG Harjola VP Parissis J Laroche C Piepoli MF Fonseca C Mebazaa A Lund L Ambrosio GA Coats AJ Ferrari R Ruschitzka F Maggioni AP Filippatos G Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry.Eur J Heart Fail. 2017; 19: 1574-1585Crossref PubMed Scopus (452) Google Scholar,2Meta-analysis Global Group in Chronic Heart Failure (MAGGIC)The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis.Eur Heart J. 2012; 33: 1750-1757Crossref PubMed Scopus (585) Google Scholar Left ventricular (LV) EF, estimated with 2-dimensional (2D) echocardiography, is the most frequently used imaging technique for the diagnosis and management of HFrEF.3Lang RM Badano LP Mor-Avi V Afilalo J Armstrong A Ernande L Flachskampf FA Foster E Goldstein SA Kuznetsova T Lancellotti P Muraru D Picard MH Rietzschel ER Rudski L Spencer KT Tsang W Voigt JU Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28 (e14): 1-39Abstract Full Text Full Text PDF PubMed Scopus (7588) Google Scholar, 4McDonagh TA Metra M Adamo M Gardner RS Baumbach A Böhm M Burri H Butler J Čelutkienė J Chioncel O Cleland JGF Coats AJS Crespo-Leiro MG Farmakis D Gilard M Heymans S Hoes AW Jaarsma T Jankowska EA Lainscak M Lam CSP Lyon AR McMurray JJV Mebazaa A Mindham R Muneretto C Francesco Piepoli M Price S Rosano GMC Ruschitzka F Kathrine Skibelund A ESC Scientific Document Group2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2021; 42: 3599-3726Crossref PubMed Scopus (3284) Google Scholar, 5Heidenreich PA Bozkurt B Aguilar D Allen LA Byun JJ Colvin MM Deswal A Drazner MH Dunlay SM Evers LR Fang JC Fedson SE Fonarow GC Hayek SS Hernandez AF Khazanie P Kittleson MM Lee CS Link MS Milano CA Nnacheta LC Sandhu AT Stevenson LW Vardeny O Vest AR Yancy CW 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines.Circulation. 2022; 145: e876-e894PubMed Google Scholar However, the assessment of LV systolic performance with 2D LVEF has several limitations, including its reliance on geometrical assumptions.6Cikes M Solomon SD Beyond ejection fraction: an integrative approach for assessment of cardiac structure and in heart failure.Eur Heart J. PubMed Scopus Google Scholar LVEF LV in patients with and of into the left or V JJ of left ventricular strain in patients with and 33: PubMed Scopus Google Scholar LV global longitudinal strain (GLS) is a to LV systolic and the are associated with the assessment of LV systolic performance by 2D M The of echocardiographic imaging in PubMed Scopus Google Scholar, D E ER JJ V of left ventricular systolic in patients with and preserved left ventricular ejection fraction: echocardiographic Heart J 2015; Google Scholar, V V JJ Left ventricular systolic assessment in secondary left ventricular ejection fraction global longitudinal Heart J. PubMed Scopus Google Scholar In has its and prognostic value 2D LVEF in including heart and are frequently in patients with O Lainscak M Seferovic PM Anker SD Crespo-Leiro MG Harjola VP Parissis J Laroche C Piepoli MF Fonseca C Mebazaa A Lund L Ambrosio GA Coats AJ Ferrari R Ruschitzka F Maggioni AP Filippatos G Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry.Eur J Heart Fail. 2017; 19: 1574-1585Crossref PubMed Scopus (452) Google MG Anker SD Maggioni AP Coats AJ Filippatos G Ruschitzka F Ferrari R Piepoli MF Metra M Fonseca C J O D B J E M Chioncel O Lainscak M Seferovic PM D A F E A P A Laroche C Mebazaa A Heart Failure Association of the European Society of Society of Heart Failure Long-Term follow-up outcomes and J Heart Fail. PubMed Google AP Filippatos G Chioncel O M J F L D G R Metra M Parissis J H P M F L Heart Failure Association of the European Society of and follow-up of the Heart Failure J Heart Fail. PubMed Scopus Google Scholar the assessment of LV systolic with LV GLS an The prognostic value of LV has in a of patients with HFrEF. The present study, to the prognostic value of LV GLS in a of patients with HFrEF. an of patients with chronic HF The and first echocardiographic diagnosis of LV dysfunction, defined as an LVEF ≤45%, patients who and were Patients who had a diagnosis of baseline or who the first of follow-up were Patients clinical and echocardiographic the of the on an LVEF was first clinical data were as in the The the of the first on an LVEF was clinical data including risk and were as the of the to the clinical is based on the European Society of guideline TA Metra M Adamo M Gardner RS Baumbach A Böhm M Burri H Butler J Čelutkienė J Chioncel O Cleland JGF Coats AJS Crespo-Leiro MG Farmakis D Gilard M Heymans S Hoes AW Jaarsma T Jankowska EA Lainscak M Lam CSP Lyon AR McMurray JJV Mebazaa A Mindham R Muneretto C Francesco Piepoli M Price S Rosano GMC Ruschitzka F Kathrine Skibelund A ESC Scientific Document Group2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2021; 42: 3599-3726Crossref PubMed Scopus (3284) Google Scholar most patients were on or of the first echocardiographic diagnosis of HF with LVEF was the data on including cardiac and or were the data used in the analysis were for clinical and was by the The to the in the of of of the of J. PubMed Google Scholar The echocardiography was the first on a reduced LVEF was patients were in the left a echocardiography and and 2D were and in a for analysis and The LV and LV were on the and and LVEF was to RM Badano LP Mor-Avi V Afilalo J Armstrong A Ernande L Flachskampf FA Foster E Goldstein SA Kuznetsova T Lancellotti P Muraru D Picard MH Rietzschel ER Rudski L Spencer KT Tsang W Voigt JU Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28 (e14): 1-39Abstract Full Text Full Text PDF PubMed Scopus (7588) Google Scholar LA was on the and LV the of RM Badano LP Mor-Avi V Afilalo J Armstrong A Ernande L Flachskampf FA Foster E Goldstein SA Kuznetsova T Lancellotti P Muraru D Picard MH Rietzschel ER Rudski L Spencer KT Tsang W Voigt JU Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28 (e14): 1-39Abstract Full Text Full Text PDF PubMed Scopus (7588) Google Scholar and for The of and was and to H J J T Goldstein S Lancellotti P M F Recommendations on the echocardiographic assessment of a update from the European Association of Cardiovascular and the American Society of Am Soc Echocardiogr. 2017; Full Text Full Text PDF PubMed Google Scholar, P C A T LA Badano L Scientific Document of the European Association of Cardiovascular for the echocardiographic assessment of an from the European Association of Cardiovascular Heart J PubMed Scopus Google Scholar, D M Foster E PA J RM S P Recommendations for of a report from the American Society of Echocardiography in with the Society for Cardiovascular Am Soc Echocardiogr. 2017; Full Text Full Text PDF PubMed Scopus Google Scholar had rates and were for 2D LV GLS from the and RM Badano LP Mor-Avi V Afilalo J Armstrong A Ernande L Flachskampf FA Foster E Goldstein SA Kuznetsova T Lancellotti P Muraru D Picard MH Rietzschel ER Rudski L Spencer KT Tsang W Voigt JU Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28 (e14): 1-39Abstract Full Text Full Text PDF PubMed Scopus (7588) Google Scholar The of was and to the LV GLS was from LV LV GLS in the was on 2 were from LV GLS were as The primary end point was worsening The secondary end point was the composite of worsening HF and all-cause on mortality were from the The is to the death HF was defined as the first for worsening and of HF or a to the of the on worsening HF were by of were in the was from the of echocardiography LVEF was first patients were the occurrence of the study end of or variables by the and are as ± SD and variables as median and range variables are as and the in ratio for the primary and secondary end point the range of baseline LV a spline curve was A baseline LV GLS value >10% was derived from the spline curve the value the for the end point was baseline clinical and echocardiographic variables were compared patients an LV GLS ≤10% variables were compared the independent when whereas the was used to variables were variables were compared and were to the individual variables and study end and with 95% confidence were had a with the analysis were in the the value of baseline LVEF and LV 2 analysis was In the first baseline LVEF was in the analysis with other variables, baseline LV GLS was into the and spline were to the in the of LVEF and LV GLS risk of worsening HF and the composite of worsening HF and all-cause mortality with The 5-year event-free survival rates were estimated by the and groups were compared with the were and a p was to analysis was for and R and R for A total of 1,873 patients (mean age ± 12 years, 75% with a first echocardiographic diagnosis of LVEF were in the present of the population and to the LV GLS groups are in Patients with LV GLS ≤10% were ± 12 ± years, p and the prevalence of p p p = p = chronic p and p = were higher compared to patients with LV GLS In patients with LV GLS ≤10% were to have a of p and of p compared to patients with LV GLS patient population GLS ≤10% GLS >10% of GLS are ± = AF = = = = = = chronic = chronic = cardiac = = = left = left ventricular = left ventricular LVEF = left ventricular ejection = = = = = = in a are ± = AF = = = = = = chronic = chronic = cardiac = = = left = left ventricular = left ventricular LVEF = left ventricular ejection = = = = = = After the echocardiographic diagnosis of LVEF ≤45%, and and or were Patients with LV GLS ≤10% were to with p p p and p = were to with p = when compared to patients with LV GLS was or and of or p p = and p = were significantly whereas of p p p p and p were significantly higher in the LV GLS ≤10% group compared with the LV GLS >10% group. ± ± p ± 63 ± p and LA ± ± p were significantly in the LV GLS ≤10% group compared with the LV GLS >10% group. The of p and p was significantly higher in patients with LV GLS ≤10% compared with patients with LV GLS During a median follow-up of 60 27 to 256 patients (14%) experienced worsening rates for worsening HF follow-up were significantly higher in the LV GLS ≤10% group to compared with the LV GLS >10% group to Patients with LV GLS ≤10% had a significantly lower event-free survival compared with patients with LV GLS >10% p The baseline LV GLS and worsening HF was and LVEF was significantly associated with worsening HF in the analysis 0.97, 95% to p higher baseline was a in the risk of worsening HF, a baseline LVEF was associated with risk of worsening HF in a spline curve spline However, the the when for other 95% to p = for other baseline LVEF was associated with risk of worsening HF in spline curve analysis spline and analysis for worsening analysis LV analysis with LV of = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = in a and analysis for the composite of worsening HF and all-cause analysis LV analysis with LV of = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = = AF = = = = = = confidence = chronic = chronic = cardiac = = = = left = left ventricular = left ventricular LVEF = left ventricular ejection LV GLS = left ventricular global longitudinal = = = = = = in a In LV GLS was significantly associated with the occurrence of worsening HF, and a higher baseline LV GLS a prognosis in the 95% to p spline and analysis 0.95, 95% 0.90 to 0.99, p = 0.032) spline After a median follow-up of 60 27 to the composite end point of worsening HF and all-cause mortality occurred in 573 patients (31%). rates follow-up were significantly higher in the LV GLS ≤10% group to compared with the LV GLS >10% group to The 5-year event-free survival rates for the composite end point of worsening HF and all-cause mortality were significantly lower for patients with LV GLS ≤10% compared with patients with LV GLS >10% p LVEF was significantly associated with the composite end point on the analysis 0.97, 95% to p on the adjustment for other 0.99, 95% to p = The spline curve baseline LVEF was associated with risk of the composite of worsening HF and all-cause mortality spline However, baseline LVEF was significantly associated with the composite end point when for other on spline curve analysis spline In higher baseline LV GLS were significantly associated with a reduced risk of the composite end point of worsening HF and all-cause mortality in the 95% to p and analysis 0.94, 95% 0.90 to 0.97, p = baseline LV GLS >10% was significantly associated with risk of the composite end point in and spline spline The of the present study, including patients with HF and reduced as LV GLS is independently associated with HF and all-cause and LV GLS prognostic even adjustment for risk including and risk of patients with HF are based on is from a of and TA Metra M Adamo M Gardner RS Baumbach A Böhm M Burri H Butler J Čelutkienė J Chioncel O Cleland JGF Coats AJS Crespo-Leiro MG Farmakis D Gilard M Heymans S Hoes AW Jaarsma T Jankowska EA Lainscak M Lam CSP Lyon AR McMurray JJV Mebazaa A Mindham R Muneretto C Francesco Piepoli M Price S Rosano GMC Ruschitzka F Kathrine Skibelund A ESC Scientific Document Group2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2021; 42: 3599-3726Crossref PubMed Scopus (3284) Google PA Bozkurt B Aguilar D Allen LA Byun JJ Colvin MM Deswal A Drazner MH Dunlay SM Evers LR Fang JC Fedson SE Fonarow GC Hayek SS Hernandez AF Khazanie P Kittleson MM Lee CS Link MS Milano CA Nnacheta LC Sandhu AT Stevenson LW Vardeny O Vest AR Yancy CW 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines.Circulation. 2022; 145: e876-e894PubMed Google Scholar However, the assessment of LV systolic with LVEF has several limitations, including its reliance on geometrical are by LV M Solomon SD Beyond ejection fraction: an integrative approach for assessment of cardiac structure and in heart failure.Eur Heart J. PubMed Scopus Google Scholar In LVEF LV systolic in patients with and of the into the LA and LV and V JJ of left ventricular strain in patients with and 33: PubMed Scopus Google Scholar LV GLS a to LV systolic performance and the of LV GLS is associated with longitudinal is an and in the including M Solomon SD Beyond ejection fraction: an integrative approach for assessment of cardiac structure and in heart failure.Eur Heart J. PubMed Scopus Google Scholar In a study patients with who were for LVEF and who had who V V JJ Left ventricular systolic assessment in secondary left ventricular ejection fraction global longitudinal Heart J. PubMed Scopus Google Scholar baseline LV GLS had significantly in the group of patients with D E ER JJ V of left ventricular systolic in patients with and preserved left ventricular ejection fraction: echocardiographic Heart J 2015; Google Scholar LV GLS was in in patients with a preserved LV GLS has to a to LV in patients with M S M A P M M Left ventricular and in patients with heart failure Fail. Full Text Full Text PDF PubMed Google Scholar in patients who cardiac of HF, LV was with on In S T T T M A H T A T Global longitudinal strain by echocardiography as a for by in patients with 2021; PubMed Scopus Google Scholar LV GLS with echocardiography and by cardiac in patients with and LV GLS was significantly in patients who had In the present study, the of patients with was and the prevalence of patients with was and are in LVEF LV systolic or the of In LV GLS the LV GLS is a of LV systolic dysfunction, LV GLS have prognostic in patients with HFrEF. have the prognostic value of LV GLS in patients with J A C L D B P P of longitudinal on the prognosis of chronic heart failure PubMed Scopus Google B T Fang JC M B risk ejection fraction in chronic systolic heart Am Heart Scopus Google Scholar However, a of patients or echocardiographic In patients with HF and reduced M T T Global longitudinal strain is a of all-cause mortality in heart failure with reduced ejection 2015; PubMed Scopus Google Scholar LV GLS was independently associated with all-cause The present study, an even on and LV GLS is independently associated with all-cause mortality and prognostic value LVEF in patients with HFrEF. In the present study for baseline clinical and echocardiographic variables, and and and for baseline LV GLS and independently associated with even or for HFrEF. in the present study, LV GLS was significantly associated with worsening HF was M T T Global longitudinal strain is a of all-cause mortality in heart failure with reduced ejection 2015; PubMed Scopus Google Scholar HF optimal of J E M worsening chronic heart failure as an and an end point in clinical worsening heart failure as a for a PubMed Scopus Google Scholar has to associated with poor prognosis in J M T MM of patients with worsening heart failure with reduced ejection Am PubMed Scopus Google Scholar, C F Stevenson LW L J M T C C G M mortality of Am Heart PubMed Scopus Google Scholar, S Stevenson LW S mortality in the population with heart Heart J. PubMed Scopus Google Scholar and is used as an in HF B J Hernandez AF Butler J Lam CSP P G SE L J in patients with heart failure and reduced ejection J PubMed Scopus Google Scholar, JJ M J AR Solomon SD and in heart J PubMed Scopus Google Scholar, JJV Solomon SD SE L FA P MS J Böhm M M J A J T M B JC E M S S C O M and in patients with heart failure and reduced ejection J PubMed Scopus Google Scholar the prognostic value of LV GLS for the end point of worsening HF value in patients with HF and LV systolic The assessment of LV GLS risk and clinical in patients with HF and reduced In patients with a LVEF of optimal an LV GLS value the of a LVEF whereas a LV GLS the of LVEF L A E M global longitudinal strain of left ventricular in heart failure patients with a left ventricular ejection Heart Fail. 2017; PubMed Scopus Google Scholar A G M P E A L R M G E A V G A G C L M M A M M imaging by strain in chronic heart failure a echocardiographic Heart Fail. PubMed Scopus Google Scholar investigated the value of LV GLS to LV in patients with who were with an Patients who LV in and LVEF months follow-up had higher LV GLS baseline compared with in LVEF or in and LVEF LV GLS an prognostic value compared with LVEF when used for risk of patients with HF and secondary D SM F V PA S S M J JJ ventricular global longitudinal strain as a of outcomes in patients with heart failure with secondary the Am Soc Echocardiogr. 2021; Full Text Full Text PDF PubMed Scopus Google F P V SE B J V JJ value of left ventricular global longitudinal strain in patients with secondary Am PubMed Scopus Google Scholar In patients who were with in the of the for Heart Failure Patients with LV GLS was independently associated with outcomes months D SM F V PA S S M J JJ ventricular global longitudinal strain as a of outcomes in patients with heart failure with secondary the Am Soc Echocardiogr. 2021; Full Text Full Text PDF PubMed Scopus Google Scholar In HF patients who R D V JJ value of global longitudinal strain in heart failure patients with cardiac Full Text Full Text PDF PubMed Scopus Google Scholar baseline LV GLS was significantly associated with the composite end point of all-cause heart and LV the LV GLS prognostic value LVEF when patients with who or The present study has several used in the present study were derived from a and were Patients with echocardiographic for LV GLS analysis were in LV GLS is and compared data were by all-cause and was to cardiac of In conclusion, baseline LV GLS is a to LV systolic and is independently associated with long-term outcomes in patients with HFrEF. LV GLS prognostic value when compared to LVEF and the of LV GLS in clinical practice to risk of patients with HFrEF. The have of to who to have as

Topics & Concepts