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

Kristoffer Grundtvig Skaarup*, Mats C.H. Lassen, Niklas D. Johansen, Morten Sengeløv, Jacob L. Marott, Peter G. Jørgensen, Gorm Jensen, Peter Schnohr, Eva Prescott, Peter Søgaard, Gunnar Gislason, Rasmus Møgelvang, Tor Biering-Sørensen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


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 (GLSWW), endomyocardial (GLSEndo), and epimyocardial (GLSEpi) 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, GLSWW [hazard ratio (HR) 1.16, 95% confidence interval (CI) 1.02–1.31, per 1% decrease] and GLSEpi (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 GLSEpi being the only layer-specific prognosticator in males, while no GLS parameter provides independent prognostic information in females.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Publication statusE-pub ahead of print - 29. Jul 2021

Bibliographical note

Publisher Copyright:
© 2021 European Society of Cardiology


  • Cardiovascular death
  • General population
  • Heart failure
  • Layer-specific global longitudinal strain
  • Two-dimensional speckle tracking echocardiography


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