Clinical Usefulness of Left Ventricular Global Longitudinal Strain as a Predictor of Prognosis in Patients With Acute Ischemic Stroke (GLS-STROKE Study)

Abstract

Background The prognostic role of left ventricular global longitudinal strain (LV-GLS) in acute ischemic stroke (AIS) remains unexplored despite its established value in cardiovascular conditions. We aimed to investigate the prognostic value of LV-GLS in patients with AIS. Methods In this prospective cohort study, 698 patients with AIS (mean age, 67.6 +/- 13.8 years; 60.2% men) underwent transthoracic echocardiography using speckle-tracking to measure LV-GLS within 7 days of admission. The primary end points included all-cause death and recurrent ischemic stroke, with a 3-month modified Rankin Scale score >= 3 considered a poor outcome. Results Over a median follow-up of 593 days, the primary end point occurred in 65 patients (9.3%), with significant differences in LV-GLS between those reaching the end point (16.3%) and the others (19.1%; P<0.001). Cox regression demonstrated LV-GLS as a statistically significant predictor of outcomes (adjusted hazard ratio, 0.81 [95% CI, 0.74-0.89]; P<0.001). Additional analyses showed that LV-GLS enhanced predictive performance for the primary end point, indicated by improvements in global chi(2) and continuous net reclassification index analyses (0.25 [95% CI, 0.01-0.42]; P=0.044). Subgroup analysis revealed the prognostic relevance of LV-GLS irrespective of atrial fibrillation status. In predicting a poor functional outcome, LV-GLS also provided incremental value over traditional risk factors and the initial National Institutes of Health Stroke Scale score (continuous net reclassification index, 0.27 [95% CI, 0.09-0.45]; P=0.004). Conclusions LV-GLS is a robust predictor of cardiocerebrovascular outcomes in AIS and offers incremental prognostic value beyond traditional risk factors. Incorporating LV-GLS into AIS management may help identify high-risk patients and guide intensive monitoring strategies.