Improving the Characterization of Stage A and B Heart Failure by Adding Global Longitudinal Strain

K. Haji, Q. Huynh, C. Wong, S. Stewart, M. Carrington, T.H. Marwick

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Current guidelines distinguish stage B heart failure (SBHF) (asymptomatic left ventricular [LV] dysfunction) from stage A heart failure (SAHF) (asymptomatic with heart failure [HF] risk factors) on the basis of myocardial infarction, LV remodeling (hypertrophy or reduced ejection fraction [EF]) or valvular disease. However, subclinical HF with preserved EF may not be identified with these criteria. Objectives: The purpose of this study was to assess the prediction of incident HF with global longitudinal strain (GLS) in patients with SAHF and SBHF. Methods: The authors analyzed echocardiograms (including GLS) in 447 patients (age 65 ± 11 years; 77% male) enrolled in a prospective study of HF in individuals at risk of incident HF, with normal or mildly impaired EF (≥40%). Long-term follow-up was obtained via data linkage. Analysis was performed using a competing risks model. Results: After a median of 9 years of follow-up, 50 (10%) of the 447 patients had new HF admissions, and 87 (18%) died. In multivariable analysis, all imaging variables were independent predictors of HF admissions, including left ventricular ejection fraction (LVEF) (HR: 0.97 [95% CI: 0.94-0.99]), LV mass index (HR: 1.01 [95% CI: 1.00-1.02]), left atrial volume index (HR: 1.02 [95% CI: 1.00-1.05]), and E/e′ (HR: 1.05 [95% CI: 1.01-1.24]), incremental to clinical variables (age and Charlson comorbidity score). However, the addition of GLS provided value incremental to both clinical and other echocardiographic parameters (P = 0.004). Impaired GLS (
Original languageEnglish
Pages (from-to)1380-1387
Number of pages8
JournalJACC: Cardiovascular Imaging
Issue number8
Publication statusPublished - 2022


  • Aged
  • Female
  • Heart Failure
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Stroke Volume
  • Ventricular Dysfunction, Left
  • Ventricular Function, Left
  • angiotensin receptor antagonist
  • beta adrenergic receptor blocking agent
  • dipeptidyl carboxypeptidase inhibitor
  • hydrochlorothiazide
  • aged
  • Article
  • cardiovascular risk factor
  • Charlson Comorbidity Index
  • childhood mortality
  • clinical assessment
  • clinical feature
  • cohort analysis
  • comparative study
  • controlled study
  • disease severity
  • echocardiography
  • effect size
  • female
  • follow up
  • global longitudinal strain
  • heart failure
  • heart left ventricle ejection fraction
  • heart left ventricle mass
  • heart left ventricle volume
  • hospital admission
  • hospitalization
  • human
  • incidence
  • major clinical study
  • male
  • prediction
  • prospective study
  • diagnostic imaging
  • heart left ventricle function
  • heart stroke volume
  • middle aged
  • predictive value
  • prognosis
  • risk factor
  • outcomes
  • risk factors
  • stage B heart failure
  • strain


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