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April 12, 2026Journal of Clinical MedicineOpen Access

Women showed significantly greater GLS than men (SMD 0.487, 95% CI 0.409–0.565; p < 0.001), while LVEF differences were not clinically meaningful (SMD 0.257, 95% CI 0.186–0.327; p < 0.001).

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Why the study?

Normal GLS reference values remain heterogeneous, and the magnitude of physiological sex differences in healthy individuals is not fully defined.

Does global longitudinal strain (GLS) differ between healthy women and men?

Comparison

Women vs men

Design

Systematic review and meta-analysis of observational studies

Authors

ASAndrea SonaglioniGGGiulio Francesco GramagliaGNGian Luigi Nicolosi

Discussion

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Overview

Supports sex-specific GLS reference values in practice; reinforces moderate-certainty evidence for tailored echocardiographic assessment.

Key Points

  • To establish pooled reference estimates for global longitudinal strain (GLS) in healthy individuals and quantify sex-related differences in myocardial deformation.
  • Conducted a systematic search of observational studies in PubMed, Scopus, and EMBASE.
  • Performed random-effects meta-analysis to compare GLS between women and men.
  • Calculated descriptive pooled reference values using weighted median and interquartile range.
  • Conducted meta-regression analyses to explore sources of heterogeneity in study outcomes.
  • Compared left ventricular ejection fraction (LVEF) between sexes in the same populations.
  • Analyzed 32 studies with 19,157 healthy individuals, showing a weighted median GLS of 20.3%.
  • Women had significantly higher GLS values than men (20.8% vs. 19.4%).
  • In a meta-analysis, women showed greater GLS with a standardized mean difference of 0.487 (p < 0.001).
  • LVEF showed no clinically meaningful differences between sexes (SMD 0.257; p < 0.001).
  • Findings indicate sex-specific GLS reference values are necessary for accurate clinical interpretation.

Structured PICO

Does global longitudinal strain (GLS) differ between healthy women and men?

P
Population
19,157 healthy individuals from 32 observational studies, weighted median age 47.5 years, 53% female.
I
Intervention
Female sex
C
Comparator
Male sex
O
Outcome
Global longitudinal strain (GLS) measured by two-dimensional or three-dimensional speckle-tracking echocardiographysurrogate

Healthy women exhibit significantly higher longitudinal myocardial deformation (GLS) than men despite comparable LVEF, supporting the adoption of sex-specific GLS reference values in clinical practice.

Limitations

  • Substantial between-study heterogeneity (I2 = 82.7%)

Cite This Study

Sonaglioni et al. (2026) studied this question.

synapsesocial.com/papers/69db37ca4fe01fead37c5e31https://doi.org/10.3390/jcm15082859
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