• Ho-Ming Su, Tsung-Hsien Lin, Po-Chao Hsu, Wen-Hsien Lee, Chun-Yuan Chu, Chee-Siong Lee, Wen-Chol Voon, Wen-Ter Lai, and Sheng-Hsiung Sheu.
• Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, , Kaohsiung, Taiwan.
• Heart. 2013 Nov 1;99(21):1588-96.

ObjectiveAlthough global left ventricular longitudinal systolic strain (GLS) is a sensitive measure of left ventricular mechanics, its relationship with adverse cardiovascular (CV) events in atrial fibrillation (AF) has not been evaluated. This study sought to examine the ability of GLS in predicting CV events in AF.DesignObservational cohort study.SettingDepartment of cardiology in a university hospital.Patients196 persistent AF patients referred for echocardiographic examination.Main Outcome MeasuresThe risk of GLS measured by index beat method for CV events was assessed by Cox proportional hazards analyses. CV events were defined as CV death, non-fatal stroke and hospitalisation for heart failure.ResultsThere were 19 CV deaths, 12 non-fatal stroke and 28 hospitalisations for heart failure during an average follow-up of 21 ± 10 months. Multivariate analysis showed worsening GLS (HR 1.121; 95% CI 1.023 to 1.228, p=0.014) was independently associated with increased CV events. In direct comparison, GLS outperformed left ventricular ejection fraction (LVEF) and systolic mitral annulus velocity (Sa) in predicting adverse CV events both in univariate and multivariate models (p ≤ 0.043). Besides, the addition of GLS to a Cox model containing chronic heart failure, hypertension, age ≥ 75 years, diabetes, prior stroke score, estimated glomerular filtration rate, LVEF and Sa provided an additional benefit in the prediction of adverse CV events (p=0.022).ConclusionsGLS was a major parameter and stronger than LVEF and Sa in predicting adverse CV events and could offer an additional prognostic benefit over conventional clinical and echocardiographic systolic parameters in AF.

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