Long term outcome
Median follow-up was 7.7 years (IQR 6.7-8.2 years). There was no
difference in long-term all-cause mortality between groups (Table 4).
Long-term MACE occurred in 92 patients (17.5%). Cardiac death was very
low in both groups, and there was no significant difference in long-term
MACE or in the individual end-points between groups (Table 4, Figure 2).
ACS or revascularization accounted for 68/92 (74%) of MACE.
Hospitalization for heart failure was rare even in the group of patients
with worse GLS. We repeated the analysis with a GLS cutoff value of
-17%, the cutoff value for abnormal GLS.24 There was
no significant difference in long-term MACE between patients with normal
vs. abnormal GLS (log-rank P =0.64).
To determine whether suboptimal 2D image quality was the cause of our
findings, we repeated the same analysis in the 164 patients with optimal
2D image quality (better GLS: n= 97, worse GLS: n=67). Long-term MACE
tended to be higher in the worse GLS group (HR=1.85, 95%CI 0.94-3.63,P =0.07(, but there was no statistically significant difference in
MACE after adjustment for history of CAD, hypertension and ACS at
presentation (HR=1.51, 95% CI 0.76-3.0, P =0.24).
Independent predictors of long-term MACE were male gender, hypertension,
history of CAD and ACS at presentation (Table 5). Thus, a worse GLS did
not predict long-term outcome.