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Introduction: In patients with heart failure, global longitudinal strain (GLS) early detects decreased ventricular contractility, with prognostic value, but there is no evidence that GLS properly differentiates etiologies in patients with left ventricular ejection fraction <50%.

Methods and aims: 147 patients with heart failure and left ventricular ejection fraction <50% were included retrospectively. The aims were to compare the GLS in patients with heart failure with reduced (<40%) to those with mildly reduced ejection fraction (40-49%) and, to compare GLS between the different etiologies in each of these two subpopulations.

 Results: 78 patients presented mildly reduced (53%) and 69 reduced ejection fraction (47%). The mean GLS was -13.4% ± 3.3% (mildly reduced -14.9% ± 2.9%, reduced -11.7% ± 3.0%, p <0.001). In mildly reduced ejection fraction, the etiologies were ischemic (47.4%), idiopathic (25.6%), tachycardiomyopathy (12.8%), valvular (11.6%), and toxic (2.6%), with similar mean GLS (p = ns among all etiologies). In reduced ejection fraction, the etiology of 50.7% patients was ischemic, 24.6% idiopathic, 10.1% valvular, 8.7% tachycardiomyopathy, and 5.8% toxic, with similar mean GLS (p = ns among all etiologies).

Conclusions: There were no significant differences in GLS between the etiologies of heart failure in any subpopulation. The reduced ejection fraction patients presented worse GLS.