The prognostic role of global longitudinal strain in heart failure: exploring beyond ejection fraction

Abstract Background Heart failure (HF) guidelines primarily rely on left ventricular ejection fraction (LVEF) to classify patients and guide therapy implementation. However, LVEF alone may be insufficient to adequately characterize patients with HF, particularly those with HF with preserved ejection fraction (HFpEF). There is a growing need to advance cardiac imaging, especially echocardiography, to improve the phenotypic and prognostic characterization of HF, ultimately guiding more precise therapy and follow-up strategies. LV global longitudinal strain (GLS), which directly reflects the motion of the myocardium, is believed to provide a better assessment of myocardial function. Purpose We aim to explore whether LV GLS predicts adverse clinical cardiovascular outcomes. Methods In this retrospective cohort study, patients diagnosed with HFmrEF/HFpEF (defined as LVEF ≥40%), according to the HFA–PEFF diagnostic algorithm, were included. Exclusion criteria inlcuded primary valvular disease, any prior LVEF