Impact of global longitudinal strain on long-term survival and transplant-free survival in fontan patients
Bibliographic record
Abstract
Abstract Background Patients with single-ventricle physiology undergoing Fontan operations face a high risk of morbidity and mortality. Classic-pattern dyssynchrony (CPD) and protein-losing enteropathy (PLE) have been established as significant predictors of adverse outcomes in these patients. However, the role of global longitudinal strain (GLS) as an independent predictor of outcomes is less clear, particularly when patients with CPD and PLE are excluded from analyses. Purpose This study aims to evaluate the predictive value of GLS for mortality and transplantation in Fontan patients, in addition to CPD and PLE. Furthermore, we intended to enhance the understanding of GLS as a potential tool for risk stratification and management in this high-risk population, thereby improving their long-term, transplant-free survival. Methods A retrospective cohort study was conducted involving 132 Fontan operated patients. Echocardiographic data, including GLS, were collected and analyzed using speckle tracking derived strain analysis. The primary endpoint was transplant-free survival. Results In this retrospective cohort study of 132 Fontan patients, we identified 15 patients with classic-pattern dyssynchrony (CPD), and 29 with protein-losing enteropathy (PLE). among all other patients we identified 37 with moderately reduced global longitudinal strain (GLS <-8% ≥-16%), 18 with highly reduced GLS (≥-8%) and 33 individuals with GLS <-16%. Multivariate Cox regression analysis demonstrated that moderately reduced GLS indicated increased risk at a hazard ratio (HR) of 5.8, with a 95% confidence interval (CI) of 1.27 to 26.5 and a p-value of 0.023, for predicting mortality or transplantation highly reduced GLS had an HR of 10.3 (95% CI: 2.18 -48.6 p=0.003). This predictive power was comparable to CPD, which had an HR of 11.5 (95% CI: 2.39 -55.6, p=0.002) and PLE, with an HR of 14.9 (95% CI: 3.32-66.4, p<0.001). Conclusion Low GLS is a powerful independent predictor of long-term Tx free survival in Fontan patients, in addition to CPD and PLE. These findings underscore the importance of incorporating GLS assessment in the routine follow-up of Fontan patients to identify high-risk individuals who may benefit from early treatment. Further research is warranted to explore the underlying mechanisms and potential therapeutic strategies to improve outcomes in this vulnerable population. Figure 1: Survival Function for PLE (Protein losing enteropati), CPD (Classic pattern dyssynchrony) and Low and moderately reduced GLS (Global longitudinal strain) compared to the General Fontan Group (all Fontan patients without any of these risk factors). Figure 2: Overview over Death/Tx in dependency of Age, and the different risk factors like PLE (Protein losing enteropati), CPD (Classic pattern dyssynchrony) and Longitudinal Strain. Survivors are circles, patients who died or were transplanted are marked as triangles. Figure 1 Figure 2
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".