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Background: Longitudinal global strain by speckle tracking appears to be more accurate than left ventricular ejection fraction (LVEF) for the characterization of myocardial dysfunction, and may therefore be a useful alternative for computation of EuroSCORE, and hence for predicting outcome after cardiac surgery.Methods and Results: LVEF (by Simpson biplane) and longitudinal global strain (by speckle tracking) were computed in 306 patients (mean age 67±13 years, 70% male, LVEF 48±13%) referred for cardiac surgery (104 coronary artery bypass graft [CABG], 141 valve surgery, 54 CABG+valve surgery, and seven other). To compute logistic EuroSCORE, left ventricular function was graded as preserved (LVEF >50%, strain <–15%), moderately impaired (LVEF 30-50%, strain -7% to -15%), or severely impaired (LVEF <30%, strain >-7%). Despite a correlation between LVEF and global strain (r=-0.73, p<0.0001), impaired global strain was observed in 47/158 patients (30%) with preserved LVEF, and only 13/36 patients (36%) with severely impaired LVEF had severely impaired strain. Postoperative death occurred in more patients with severely impaired strain (26% versus 8%; P=0.007), but no correlation was observed between death and LVEF. Among those who died, EuroSCORE by strain was greater than EuroSCORE by LVEF (27.6±24.2% versus 26.1±23.5%; P=0.02). Also, EuroSCORE by strain, but not by LVEF, remained independently associated with postoperative death by stepwise multivariable logistic regression (odds ratio, 1.05; 95% confidence interval, 1.03-1.07; P<0.0001).Conclusions: EuroSCORE computed using longitudinal global strain by speckle tracking predicts postoperative outcome better than conventional logistic EuroSCORE using LVEF.