GLS decline of 5% (absolute value) or GLS change of relative 12% (guidelines relative 15%) shows early cardiotoxicity
RV Strain & LA Strain (cut-off LASr 35%, relative reduction 10%) can be used as well to show early cardiotoxicity
GLS before chemotherapy >-17% ➜ elevation of risk for cardiotoxicity >12,3 times (all cardiotoxic chemotherapies)
GLS cut-off -15,3% to low normal for diagnosis of myocarditis
Elevated risk for CV-events -15% in normal EF. In reduced EF cut-off -10%,
Worse prognosis cut-off >-12% (3a)
Acute myocarditis often affects the lateral segments (GLS -17%, lateral -13% vs. -20%, -21% in normal segments) — low-normal GLS as cut-off — „mirror“ to MRI & lateral involvement
Myocarditis in COVID-19
GLS >-13,8% denotes poor prognosis in critical COVID-19 disease
Subclinical changes, especially lateral reduction, in the acute & follow-up setting
RV FWS >-23% as a marker of poor prognosis in the acute setting
Dilated CMP
GLS -10% as a predictor for LV reverse remodeling in SR & cut-off for elevated VT risk in dil. CMP
GLS -10% as GLS & mechanical dispersion as markers for ventricular arrhythmia (cut-off dispersion >70ms)
Ischemic heart disease ➜ Dispersion >70ms ➜ VT risk severely elevated with 16%/year; <70ms and dilatative CMP lowest risk with 3%/year
GLS measurement better than EF for risk stratification, Dispersion as EF-independent risk parameter
Peripartum CMP
GLS drops in the 3rd trimester from -19% (1st and 2nd Trimester) to -17,6% with a normalisation postpartum
-18% (2nd Trimester) as a cut-off in pregnant women (>35a) as a marker for an increase in „adverse maternal outcomes“
LASr & LASct drop (40%/-17% in the 1st, 37%/-15% in the 2nd & 33%/-13% in the 3rd Trimester) and recovers postpartum
Peripartum CMP recurrence cut-off -16% (with GLS -12%, close to 100% probability for recurrence)
Heart transplant rejection
Acute rejection (Antibody-mediated (AMR) & cellular mediated (ACR)) with a reduction in GLS; GLS reduction as an early marker
GLS reduction cut-off -15,5% in AMR 3 months before clinical event; AMR — acute (rejection) and in the follow-up, gradual reduction in GLS
ACR — reduction in GLS in acute rejection, improvement in the follow-up
FWS cut-off for > Grad 1 rejection -17%
