Global Longitudinal Strain Assessment in Cardiac Function

Global longitudinal strain (GLS) has emerged as a sensitive measure of myocardial deformation, offering quantitative insight into left ventricular systolic function beyond conventional ejection fraction. By tracking the longitudinal shortening of myocardial fibres, GLS detects subtle impairment in contractility that may precede overt changes in volumetric measures. Acquired most commonly by speckle tracking echocardiography or feature-tracking cardiovascular magnetic resonance, GLS provides a reproducible index of regional and global myocardial mechanics. Its prognostic value spans a range of cardiac conditions— from dilated cardiomyopathy and ischaemic heart disease to subclinical dysfunction in metabolic or hematological disorders— and it informs risk stratification, therapeutic decision-making and longitudinal follow-up. Owing to its ability to unmask early systolic impairment, GLS has rapidly gained traction in both clinical practice and research, driving standardisation efforts and technical refinements to ensure robust inter-vendor reproducibility and applicability across diverse patient populations.

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Precision prognostic stratification in dilated cardiomyopathy with mildly reduced ejection fraction has been advanced by cardiovascular magnetic resonance feature‐tracking GLS. In a large cohort of patients with dilated cardiomyopathy and left ventricular ejection fraction above 40 per cent, impaired GLS identified individuals at heightened risk of progressive heart failure events, whereas late gadolinium enhancement better delineated sudden death risk. This dual-modality approach underscores the complementary roles of strain and tissue-characterisation in individualised risk prediction. Long-term outcome prediction after acute coronary syndrome has likewise benefited from the integration of GLS with conventional measures. In a multi-centre study of patients managed for acute coronary events, both GLS and ejection fraction independently forecasted the combined endpoint of all-cause mortality and heart failure rehospitalisation over a median six-year follow-up. Although GLS provided incremental discrimination in some models, its added value beyond ejection fraction varied, prompting ongoing evaluation of optimal thresholds and integration with clinical risk scores. In population research, midlife haemoglobin concentrations have been linked to myocardial mechanics through echocardiographic GLS. Higher haemoglobin levels in a community-based cohort correlated with more adverse metabolic profiles and reduced GLS despite preserved ejection fraction. These findings suggest that subclinical alterations in myocardial deformation may accompany systemic changes in oxygen-carrying capacity, even in asymptomatic subjects, and highlight the potential of GLS in epidemiological surveillance of early cardiac dysfunction.

Global Longitudinal Strain Assessment in Cardiac Function publication trend

The graph below shows the total number of articles in global longitudinal strain assessment in cardiac function across all publications each year (not limited to Nature Index journals).

Technical terms

Global Longitudinal Strain (GLS): A measure of myocardial deformation reflecting the percentage of longitudinal shortening during systole.

Left Ventricular Ejection Fraction (LVEF): The proportion of blood ejected from the left ventricle with each heartbeat, expressed as a percentage.

Speckle Tracking Echocardiography: An imaging technique that follows natural acoustic markers within the myocardium to quantify deformation.

Cardiovascular Magnetic Resonance (CMR): A non-invasive modality using magnetic fields to visualise cardiac structure and function, including strain via feature tracking.

Late Gadolinium Enhancement (LGE): A CMR technique that highlights areas of myocardial fibrosis or scar by differential uptake of contrast agent.

References

1. Precision prediction of heart failure events in patients with dilated cardiomyopathy and mildly reduced ejection fraction using multi‐parametric cardiovascular magnetic resonance. European Journal of Heart Failure (2024).
2. Global longitudinal strain in long-term risk prediction after acute coronary syndrome: an investigation of added prognostic value to ejection fraction. Clinical Research in Cardiology (2024).
3. Haemoglobin levels are associated with echocardiographic measures in a Finnish midlife population. Annals of Medicine (2024).