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Original research
Global longitudinal strain predicts cardiovascular events after coronary artery bypass grafting
  1. Flemming Javier Olsen1,
  2. Søren Lindberg1,
  3. Sune Pedersen1,
  4. Allan Iversen1,
  5. Filip Soeskov Davidovski1,
  6. Søren Galatius2,
  7. Thomas Fritz-Hansen1,
  8. Gunnar Hilmar Gislason1,3,
  9. Peter Søgaard4,5,
  10. Rasmus Møgelvang3,6,7,
  11. Tor Biering-Sørensen1,8
  1. 1Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
  2. 2Department of Cardiology, Frederiksberg and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
  3. 3Department of Clinical Medicine, Faculty of Healhy and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  4. 4Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
  5. 5Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  6. 6Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
  7. 7Department of Clinical Research, Faculty of Health and Medical Sciences, University of Southern Denmark, Odense, Denmark
  8. 8Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Flemming Javier Olsen, Herlev and Gentofte Hospital, Hellerup, Denmark; flemming.j.olsen{at}


Objective To determine the prognostic value of global longitudinal strain (GLS) after coronary artery bypass grafting (CABG).

Methods We performed a retrospective cohort study on patients undergoing CABG between 2006 and 2011 who had an echocardiogram available for strain analysis. The patients were followed up through nationwide registries for development of all-cause mortality, cardiovascular death (CVD) and major adverse cardiovascular events (MACEs) defined as heart failure hospitalisation and/or CVD. Multivariable Cox regression was applied to adjust for the European System for Cardiac Operative Risk Evaluation II (EuroSCORE-II). Additive value was assessed by Net Reclassification Index (NRI) improvement.

Results Of the 709 patients included, 80 died during a median follow-up of 3.8 years. Of these, 45 had CVD, and 72 patients experienced MACE. Mean age was 68 years and 85% were men. Left ventricular ejection fraction (LVEF) was 50% and GLS was −13%.

GLS was an independent predictor when adjusted for the EuroSCORE-II (all-cause mortality: HR=1.07 (1.01–1.13), p=0.018; CVD: HR=1.11 (1.03–1.20), p=0.007; MACE: HR=1.12 (1.06–1.19), p<0.001, per 1% absolute decrease). GLS significantly improved the NRI score by 0.30 when added to the EuroSCORE-II for predicting MACE, but not significantly for the other endpoints.

LVEF modified the association between GLS and outcomes (p for interaction<0.05 for CVD and MACE). GLS remained an independent predictor of outcomes in patients with preserved LVEF (LVEF≥50%) and improved the NRI score when added to the EuroSCORE-II for predicting CVD and MACE, but not all-cause mortality in these patients.

Conclusion GLS is an independent predictor of long-term outcomes after CABG. The predictive value appears strongest among patients with preserved LVEF.

  • echocardiography
  • coronary artery disease
  • coronary artery bypass

Statistics from


  • FJO and SL contributed equally.

  • RM and TB-S contributed equally.

  • Contributors FJO: conceptualisation, methodology, formal analysis, writing–original draft and editing. SL: conceptualisation, methodology, formal analysis, writing–editing and revising draft, and final approval.SP, AI, FSD, SG, TF-H, GHG and PS: methodology, investigation, review, editing and final approval of manuscript. RM and TB-S: conceptualisation, methodology, supervision, project administration, review, editing and final approval of manuscript. In accordance with International Committee of Medical Journal Editors authorship criteria, all authors agreed to be accountable for all aspects of the work.

  • Funding FJO was funded by a research grant from the Danish Heart Foundation (grant number 18-R125-A8534-22083). TB-S received the Fondbørsvekselerer Henry Hansen og Hustrus Hovedlegat. The sponsors had no role in study concept, design, conduction or interpretation of the data.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Retrospective studies in Denmark do not require approval by ethics committee, but the study did acquire the necessary approvals by the Danish Health and Medicines Authority as well as the Danish Data Protection Agency.

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

  • Data availability statement No data are available. Since the data presented in the present report are obtained from human patients, we are not allowed to distribute the data in accordance with the data protection rules in Denmark, and we therefore cannot make the data publicly available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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