Layer-specific global longitudinal strain and the risk of heart failure and cardiovascular mortality in the general population: the Copenhagen City Heart Study

Aims Layer-specific global longitudinal strain (GLS) has been demonstrated to predict outcome in various patient cohorts. However, little is known regarding the prognostic value of layer-specific GLS in the general population and whether different layers entail differential prognostic information. The aim of the present study was to investigate the prognostic value of whole wall (GLS(WW)), endomyocardial (GLS(Endo)), and epimyocardial (GLS(Epi)) GLS in the general population. Methods and results A total of 4013 citizens were included in the present study. All 4013 had two-dimensional speckle tracking echocardiography performed and analysed. Outcome was a composite endpoint of incident heart failure and/or cardiovascular death. Mean age was 56 years and 57% were female. During a median follow-up time of 3.5 years, 133 participants (3.3%) reached the composite outcome. Sex modified the relationship between all GLS parameters and outcome. In sex-stratified analysis, no GLS parameter remained significant predictors of outcome in females. In contrast, GLS(WW) [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.02- 1.31, per 1% decrease] and GLS(Epi) (HR 1.19, 95% CI 1.04- 1.38, per 1% decrease) remained as significant predictors of outcome in males after multivariable adjustment (including demographic, clinical, biochemistry, and echocardiographic parameters). Lastly, only in males did GLS parameters provide incremental prognostic information to general population risk models. Conclusions In the general population, sex modifies the prognostic value of GLS resulting in GLS(Epi) being the only layer-specific prognosticator in males, while no GLS parameter provides independent prognostic information in females.

Automated summary

The study found differences in the prognostic value of whole wall, endomyocardial, and epimyocardial global longitudinal strain in the general population. Sex modifies the prognostic value of GLS, with epimyocardial GLS (Epi) being the only layer-specific prognosticator in males, while no GLS parameter provides independent prognostic information in females.