Association of Global Longitudinal Strain and Long‐Term Transplant‐Free Survival in Fontan Patients
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Patients with single-ventricle physiology undergoing Fontan operations face high morbidity and mortality risks. While classic-pattern dyssynchrony (CPD) and protein-losing enteropathy (PLE) are known predictors of adverse outcomes, the role of global longitudinal strain (GLS) as an independent predictor of heart failure remains unclear. METHODS: A retrospective cohort study of 135 Fontan-operated patients from 2014 to 2015 evaluated the predictive value of GLS alongside PLE and CPD on mortality and transplantation after 9 years. Echocardiographic data, including GLS, were analyzed using speckle tracking strain analysis in 132 patients. The primary endpoint was transplant-free survival. RESULTS: Among 132 Fontan patients, 15 had classic-pattern dyssynchrony, 29 had protein-losing enteropathy, 37 had moderately reduced global longitudinal strain (GLS ←8% ≥-16%), and 18 had severely reduced GLS (≥-8%). Cox regression analysis showed moderately reduced GLS increased mortality risk (HR 5.8, 95% CI 1.27-26.5, p = 0.023), with severely reduced GLS showing an HR of 10.3 (95% CI 2.18-48.6, p = 0.003). These results were comparable to CPD (HR 11.5, p = 0.002) and PLE (HR 14.9, p < 0.001). CONCLUSION: Global longitudinal strain emerged as the best independent factor for predicting long-term transplant-free survival in Fontan patients, highlighting the importance of GLS assessment in routine follow-up to identify high-risk individuals for early intervention.
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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 | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| 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".