ORIGINAL PAPER The prognostic value of standardized reference values for speckle-tracking global longitudinal strain in hypertrophic cardiomyopathy Gregory R. Hartlage • Jonathan H. Kim • Patrick T. Strickland • Alan C. Cheng • Nima Ghasemzadeh • Maria A. Pernetz • Stephen D. Clements • B. Robinson Williams III Received: 20 November 2014 / Accepted: 9 January 2015 / Published online: 14 January 2015 Ó Springer Science+Business Media Dordrecht 2015 Abstract Speckle-tracking left ventricular global longi- tudinal strain (GLS) assessment may provide substantial prognostic information for hypertrophic cardiomyopathy (HCM) patients. Reference values for GLS have been recently published. We aimed to evaluate the prognostic value of standardized reference values for GLS in HCM patients. An analysis of HCM clinic patients who underwent GLS was performed. GLS was defined as normal (more negative or equal to -16 %) and abnormal (less negative than -16 %) based on recently published reference values. Patients were followed for a composite of events including heart failure hospitalization, sustained ventricular arrhyth- mia, and all-cause death. The power of GLS to predict outcomes was assessed relative to traditional clinical and echocardiographic variables present in HCM. 79 HCM patients were followed for a median of 22 months (inter- quartile range 9–30 months) after imaging. During follow- up, 15 patients (19 %) met the primary outcome. Abnormal GLS was the only echocardiographic variable independently predictive of the primary outcome [multivariate Hazard ratio 5.05 (95 % confidence interval 1.09–23.4, p= 0.038)]. When combined with traditional clinical variables, abnor- mal GLS remained independently predictive of the primary outcome [multivariate Hazard ratio 5.31 (95 % confidence interval 1.18–24, p= 0.030)]. In a model including the strongest clinical and echocardiographic predictors of the primary outcome, abnormal GLS demonstrated significant incremental benefit for risk stratification [net reclassification improvement 0.75 (95 % confidence interval 0.21–1.23, p\ 0.0001)]. Abnormal GLS is an independent predictor of adverse outcomes in HCM patients. Standardized use of GLS may provide significant incremental value over tradi- tional variables for risk stratification. Keywords Global longitudinal strain Á Hypertrophic cardiomyopathy Á Prognosis Á Speckle-tracking echocardiography Abbreviations CMR Cardiac magnetic resonance GLS Global longitudinal strain HCM Hypertrophic cardiomyopathy LAVI Left atrial volume index LV Left ventricle NSVT Non-sustained ventricular tachycardia NYHA New York Heart Association SRT Septal reduction therapy TTE Transthoracic echocardiography G. R. Hartlage (&) Á J. H. Kim Á P. T. Strickland Á A. C. Cheng Á N. Ghasemzadeh Á M. A. Pernetz Á S. D. Clements Á B. R. Williams III Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1364 Clifton Rd NE Room 4D33, Atlanta, GA 30322, USA e-mail: ghartlagemd@gmail.com J. H. Kim e-mail: jonathan.kim@emory.edu P. T. Strickland e-mail: pstric3@emory.edu A. C. Cheng e-mail: alan.cheng@wellstar.org N. Ghasemzadeh e-mail: nghasem@emory.edu M. A. Pernetz e-mail: maria.pernetz@emoryhealthcare.org S. D. Clements e-mail: sclemen@emory.edu B. R. Williams III e-mail: brwilli@emory.edu 123 Int J Cardiovasc Imaging (2015) 31:557–565 DOI 10.1007/s10554-015-0590-5