{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:17:51Z","timestamp":1758673071081,"version":"3.44.0"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Patients with single\u2010ventricle physiology undergoing Fontan operations face high morbidity and mortality risks. While classic\u2010pattern dyssynchrony (CPD) and protein\u2010losing enteropathy (PLE) are known predictors of adverse outcomes, the role of global longitudinal strain (GLS) as an independent predictor of heart failure remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort study of 135 Fontan\u2010operated 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\u2010free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 132 Fontan patients, 15 had classic\u2010pattern dyssynchrony, 29 had protein\u2010losing enteropathy, 37 had moderately reduced global longitudinal strain (GLS \u21908% \u2265\u201316%), and 18 had severely reduced GLS (\u2265\u20138%). Cox regression analysis showed moderately reduced GLS increased mortality risk (HR 5.8, 95% CI 1.27\u201326.5, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.023), with severely reduced GLS showing an HR of 10.3 (95% CI 2.18\u201348.6, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.003). These results were comparable to CPD (HR 11.5, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.002) and PLE (HR 14.9, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Global longitudinal strain emerged as the best independent factor for predicting long\u2010term transplant\u2010free survival in Fontan patients, highlighting the importance of GLS assessment in routine follow\u2010up to identify high\u2010risk individuals for early intervention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.70297","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T15:08:59Z","timestamp":1758208139000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Global Longitudinal Strain and Long\u2010Term Transplant\u2010Free Survival in Fontan Patients"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9084-5805","authenticated-orcid":false,"given":"Assami","family":"R\u00f6sner","sequence":"first","affiliation":[{"name":"Department of Cardiology Division of Cardiothoracic and Respiratory Medicine University Hospital of North Norway  Troms\u00f8 Norway"},{"name":"Department of Clinical Medicine (IKM) UiT The Arctic University of Norway  Troms\u00f8 Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone Goa","family":"Diab","sequence":"additional","affiliation":[{"name":"Department of Paediatric Cardiology Oslo University Hospital Rikshospitalet  Oslo Norway"},{"name":"Institute of Clinical Medicine Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark K.","family":"Friedberg","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology Labatt Family Heart Center Hospital for Sick Children and University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George K.","family":"Lui","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Department of Medicine Stanford University School of Medicine  Stanford California USA"},{"name":"Division of Pediatric Cardiology Department of Pediatrics Stanford University School of Medicine  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307467"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.09.002"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2017.11.007"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13019-023-02148-x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2023.08.176"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2021.100825"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2022.01.012"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2023.04.021"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.4103\/jcecho.jcecho_24_22"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2018.07.005"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0218492320949655"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.03.312"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2017.10.018"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-39226-y"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2019.12.041"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-023-00984-3"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.117.006738"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.07.011"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-022-00884-y"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.767503"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.07.065"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab826"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.738559"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2016-310108"},{"issue":"6","key":"e_1_2_8_26_1","first-page":"441","article-title":"Single Ventricle\u2010A Comprehensive Review","volume":"8","author":"Rao P. 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