Global Longitudinal Active Strain Energy Density (GLASED): A Powerful Prognostic Marker in a Community-Based Cohort

ABSTRACT BACKGROUND Identifying the imaging methods that best predict heart failure risk, cardiovascular adverse events and death is crucial for tailoring optimal management. Potential prognostic markers include myocardial mass, left ventricular ejection fraction, myocardial strain, stroke work, contraction fraction, pressure-strain product and a new measurement called global active longitudinal strain density (GLASED). OBJECTIVES This study sought to assess the utility of a range of potential prognostic markers of left ventricular structure and contractile function in a community-based cohort. METHODS The impact of cardiovascular magnetic resonance image-derived markers, extracted by machine learning algorithms were compared to the future risk of adverse events in a group of 44,957 UK Biobank participants. RESULTS Most markers, including the left ventricular ejection fraction, had limited prognostic value. GLASED was significantly associated with heart failure, all-cause mortality and major adverse cardiovascular events with hazard ratios of approximately 1.4. CONCLUSIONS GLASED predicted major cardiovascular adverse events and mortality with the highest hazard ratios compared with conventional markers. The routine use of GLASED is recommended for assessing prognosis. Graphical abstract