Global Longitudinal Strain (GLS) in Elderly and Its Associated Factors

Mohamad Syahrir Azizi, Sally Aman Nasution, Siti Setiati, Hamzah Shatri


Background: cardiovascular disease is very common and can be fatal in elderly patients. It is often preceded by asymptomatic or subclinical left ventricular systolic dysfunction (LVSD). Early detection of LVSD can reduce morbidity and mortality due to cardiovascular disease. One method used in the early detection of LVSD is an assessment of global longitudinal strain (GLS). This study aimed to determine the mean value of GLS and GLS-related factors. Methods: this cross-sectional study was conducted among elderly patients aged > 60 years in the geriatric and cardiology clinic, Internal Medicine, CMH Hospital. Data were obtained from interviews, medical records, and transthoracic echocardiography examination. The variables of age, frailty, hypertension, coronary artery disease, dyslipidemia, and diabetes mellitus were analyzed as the determinants of a decrease in GLS. Univariate analysis was conducted for each variable. Bivariate analysis was conducted using the chi-square test with a significance level of p<0.25 and confidence interval (CI) of 95%, and multivariate analysis used a logistic regression test. Results: a total of 194 patients were admitted according to the study criteria, with a mean age of 66 years. The proportion of women was 60.8%. The study revealed that the determinants with p<0.25 are frailty, hypertension, dyslipidemia, and diabetes mellitus, with multivariate analysis frailty having an OR of 2.002 (95% CI 1.042–3.925) and diabetes mellitus having an OR of 2.278 (95% CI 1.033–5.025). Conclusion: the mean value of GLS among the elderly was -21.6% (minimum value -5.3% and maximum value 29.9%). The factors that influence the decrease of GLS are frailty and diabetes mellitus.


global longitudinal strain (GLS); left ventricular systolic dysfunction (LVSD); frailty


Ammirati E, Rimoldi OE, Camici PG. Is there evidence supporting coronary revascularization in patients with left ventricular systolic dysfunction? Circ J. 2011;75: 3–10.

Yancy CW, Jessup M, Bozkurt B, et al. ACCF/AHA Guideline for the management of heart failure: executive summary. J Am Col Cardiol. 2013;128: 1810–52.

Cioffi G, Viapiana O, Ognibeni F, et al. Prognostic role of subclinical left ventricular systolic dysfunction evaluated by speckle-tracking echocardiography in rheumatoid arthritis. J Am Soc Echocardiogr. 2017;30: 602–11.

Ayoub AM, Keddeas VW, Ali YA, et al. Subclinical LV dysfunction detection using speckle tracking echocardiography in hypertensive patients with preserved LV ejection fraction. Clin Med Insights Cardiol. 2016;10:85–90.

Leng S, Chen X, Mao G. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433–41.

Wang TJ, Levy D, Benjamin EJ, et al. The epidemiology of ‘asymptomatic’ left ventricular systolic dysfunction: Implications for screening. Ann Intern Med. 2003;138: 907–16.

Hung C-L, Goncalves A, Shah AM, et al. Age and gender-related influences on left ventricular mechanics in elderly individuals free of prevalent heart failure: The atherosclerosis risk in communities study. Circ Cardiovasc Imaging. 2017;10:784–90.

Nadruz W, Kitzman D, Windham BG, et al. Cardiovascular dysfunction and frailty among older adults in the community: The ARIC study. J Gerontol A Biol Sci Med Sci. 2017;72:958–64.

Holland DJ, Marwick TH, Haluska BA, et al. Subclinical LV dysfunction and 10-year outcomes in type 2 diabetes mellitus. Heart. 2015;101:1061–6.

Mahalle N, Garg M, Naik S, et al. Study of pattern of dyslipidemia and its correlation with cardiovascular risk factors in patients with proven coronary artery disease. Indian J Endocrinol Metab. 2014;18:48–55.

Miller M. Dyslipidemia and cardiovascular risk: The importance of early prevention. Q J Med. 2009;102: 657–67.

Russo C, Jin Z, Elkind MSV, et al. Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort. Eur J Hear Fail. 2014;16: 1301–9.

Liou K, Negishi K, Ho S, et al. Detection of obstructive coronary artery disease using peak systolic global longitudinal strain derived by two-dimensional speckle-tracking: A systematic review and meta-analysis. J Am Soc Echocardiogr. 2016;29:724–35.

Seto E, Setiati S, Laksmi PW, et al. Diagnostic test of a scoring system for frailty syndrome in the elderly according to cardiovascular health study, study of osteoporotic fracture and comprehensive geriatric assessment based frailty index compared with frailty index 40 items. Acta Med Indones-Indones J Intern Med. 2015;47:183–7.

Russo C, Jin Z, Homma S, et al. Race-ethnic differences in subclinical left ventricular systolic dysfunction by global longitudinal strain: A community-based cohort study. Am Hear J. 2015;169:721–6.

Poppe K. A meta-analysis of echocardiographic measurements of the left heart for the development of normative reference ranges in a large international cohort: The EchoNoRMAL study. Eur Hear J. 2014;15:341–8.

Soufi Taleb Bendiab N, Meziane-Tani A, Ouabdesselam S, et al. Factors associated with global longitudinal strain decline in hypertensive patients with normal left ventricular ejection fraction. Eur J Prev Cardiol. 2017; 24:1463–72.

Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2014;27:911–9.

Setiati S, Kedokteran P, Indonesia D. Geriatric medicine, sarcopenia, frailty and geriatric quality of life: Future challenge in education, research and medical service in Indonesia. eJKI. 2013;1:234–42.

Leon BM. Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes. 2015;6:1246.

Montalescot G, Sechtem U, Achenbach S, et al. Guidelines on the management of stable coronary artery disease. Eur Hear J. 2013;34:2949–3003.

Biering-Sørensen T, Hoffmann S, Mogelvang R, et al. Myocardial strain analysis by 2-dimensional speckle tracking echocardiography improves diagnostics of coronary artery stenosis in stable angina pectoris. Circ Cardiovasc Imaging. 2014;7:58–65.

Zhang P, Li D, Su Y, et al. Assessment of myocardial strain in children with risk factors for atherosclerosis with use of 3D speckle tracking echocardiography. Echocardiography. 2018;35:487–93.

Vitarelli A, Martino F, Capotosto L, et al. Early myocardial deformation changes in hypercholesterolemic and obese children and adolescents: A 2D and 3D speckle tracking echocardiography study. Med (United States). 2014;93:1–10.

Full Text: PDF


  • There are currently no refbacks.