Impaired LS , defined as an absolute LS < 15.8 % , was present in 52 % of patients and was predictive of the composite outcome ( adjusted hazard ratio , 2.14 ; 95 % confidence interval , 1.26-3 .66 ; P = 0.005 ) , cardiovascular death alone ( adjusted hazard ratio , 3.20 ; 95 % confidence interval , 1.44-7 .12 ; P = 0.004 ) , and HF hospitalization alone ( adjusted hazard ratio , 2.23 ; 95 % confidence interval , 1.16-4 .28 ; P = 0.016 ) after adjustment for clinical and conventional echocardiographic variables .