{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T08:19:52Z","timestamp":1793089192969,"version":"4.5.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2014,1,27]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The utility of longitudinal, circumferential, and radial strain and strain rate in determining prognosis in chronic heart failure is not well established.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In 416 patients with chronic systolic heart failure, we performed speckle\u2010tracking analyses of left ventricular longitudinal, circumferential, and radial strain and strain rate on archived echocardiography images (30 frames per second). Cox regression models were used to determine the associations between strain and strain rate and risk of all\u2010cause mortality, cardiac transplantation, and ventricular\u2010assist device placement. The area under the time\u2010dependent\n              <jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>\n              curve (\n              <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>\n              ) was also calculated at 1 year and 5 years. Over a maximum follow\u2010up of 8.9\u00a0years, there were 138 events (33.2%). In unadjusted models, all strain and strain rate parameters were associated with adverse outcomes (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In multivariable models, all parameters with the exception of radial strain rate (\n              <jats:italic>P<\/jats:italic>\n              =0.11) remained independently associated, with patients in the lowest tertile of strain or strain rate parameter having a \u22482\u2010fold increased risk of adverse outcomes compared with the reference group (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05). Addition of strain to ejection fraction (\n              <jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>\n              ) led to a significantly improved\n              <jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>\n              at 1\u00a0year (0.697 versus 0.633,\n              <jats:italic>P<\/jats:italic>\n              =0.032) and 5\u00a0years (0.700 versus 0.638,\n              <jats:italic>P<\/jats:italic>\n              =0.001). In contrast, strain rate did not provide incremental prognostic value to\n              <jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>\n              alone.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Longitudinal and circumferential strain and strain rate, and radial strain are associated with chronic heart failure prognosis. Strain provides incremental value to\n              <jats:styled-content style=\"fixed-case\">EF<\/jats:styled-content>\n              in the prediction of adverse outcomes, and with additional study may be a clinically relevant prognostic tool.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.113.000550","type":"journal-article","created":{"date-parts":[[2014,1,14]],"date-time":"2014-01-14T04:54:18Z","timestamp":1389675258000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":88,"title":["Strain Improves Risk Prediction Beyond Ejection Fraction in Chronic Systolic Heart Failure"],"prefix":"10.1161","volume":"3","author":[{"given":"Kathleen W.","family":"Zhang","sequence":"first","affiliation":[{"name":"Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"French","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"},{"name":"Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"May Khan","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ted","family":"Plappert","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"Fang","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Case Western Reserve University, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy K.","family":"Sweitzer","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, University of Wisconsin, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry A.","family":"Borlaug","sequence":"additional","affiliation":[{"name":"Cardiovascular Medicine, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio A.","family":"Chirinos","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"St. John Sutton","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas P.","family":"Cappola","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Ky","sequence":"additional","affiliation":[{"name":"Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"},{"name":"Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(97)70057-7"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.10.3294"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(03)00789-7"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-137-8-200210150-00006"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(05)80242-X"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.11.063"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jer021"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.647172"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.07.047"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.06.044"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.04.061"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.111.970434"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.856310"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1017494108"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2005.10.005"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01651-5"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.659763"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.110.958223"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0006-341X.2000.00337.x"},{"key":"e_1_3_3_21_2","article-title":"Development 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Development and evaluation of multi\u2010marker risk scores for clinical prognosis. Stat Methods Med Res. 2012 [Epub ahead of print].","journal-title":"Stat Methods Med Res"},{"key":"e_1_3_3_22_2","unstructured":"Heagerty P Saha\u2010Chaudhuri P. 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