Article Text

Download PDFPDF
Original article
Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy
  1. Misato Chimura,
  2. Tetsuari Onishi,
  3. Yasue Tsukishiro,
  4. Takahiro Sawada,
  5. Kunihiko Kiuchi,
  6. Akira Shimane,
  7. Katsunori Okajima,
  8. Shinichiro Yamada,
  9. Yasuyo Taniguchi,
  10. Yoshinori Yasaka,
  11. Hiroya Kawai
  1. Himeji Cardiovascular Center, Himeji, Japan
  1. Correspondence to Dr Tetsuari Onishi, Department of Cardiology, Himeji Cardiovascular Center, 520 Saisho-ko, Himeji 670-0981, Japan; tetsuari{at}


Objective Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging has been reported to be associated with unfavourable outcomes; however, few studies have addressed the prognostic value of left ventricular (LV) deformation parameter indicated by global longitudinal strain (GLS) in two-dimensional speckle-tracking (2DST) echocardiography in patients with non-ischaemic dilated cardiomyopathy (DCM). This study aims to investigate whether the combination of GLS and LGE is useful in stratifying the risk in patients with DCM.

Methods We studied 179 consecutive symptomatic patients with DCM (age, 61±15 years; 121 males; left ventricular ejection fraction (LVEF) 33%±9%; New York Heart Association (NYHA) class II: n=71, III: n=107, IV: n=1) who underwent CMR and echocardiography with conventional assessment and 2DST analysis.

Results There were 40 rehospitalisations for heart failure, including 7 cardiac deaths and 2 implantations of LV assist device during follow-up (3.8±2.5 years). Univariable Cox proportional hazard regression analysis showed that NYHA class, blood pressure, B-type natriuretic peptide, LV end-diastolic and end-systolic volumes, LVEF, left atrium volume, GLS and LGE were significantly associated with long-term outcome. Multivariable analysis revealed that GLS and LGE were independently associated with long-term outcome (p<0.05, both). In additional analyses, we found independent associations between GLS and LV reverse remodelling after the optimal medical therapy, and between LGE and life-threatening arrhythmias (p<0.05, both).

Conclusion Combining GLS and LGE could be useful for risk stratification and prognostic assessment in patients with DCM.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors MC and TO: conception or design of the work and drafting the article. YT, TS and KK: data collection. MC, TO, AS, KO, SY and YT: data analysis and interpretation. MC, TO and HK: critical revision of the article. YY and HK: final approval of the version to be published.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The Institutional Review Board and the Ethics Committees of the Himeji Cardiovascular Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.