Comparison of left ventricular longitudinal systolic function parameters in the prediction of adverse outcome in heart failure with preserved ejection fraction

Abstract

Aims Several different diagnostic parameters can be used to assess left ventricular (LV) longitudinal systolic function, but no studies comparing their predictive value have been conducted. We sought to compare the prognostic value of LV long-axis function parameters at rest and exercise using the population with heart failure with preserved ejection fraction (HFpEF). Methods and results Clinical and biochemical variables were collected at baseline in 201 patients with HFpEF. Echocardiography was performed at rest and immediately after exercise, with measurement of mitral annular plane systolic excursion, systolic tissue velocity (s′), global longitudinal strain (GLS), and global longitudinal strain rate (GLSR). Participants were followed for 48 (24-60) months for heart failure hospitalization and cardiovascular death. Seventy-four patients (36.8%) met the study endpoint. Cox regression analysis revealed that after adjustment for Meta-Analysis Global Group in Chronic Heart Failure risk score, brain natriuretic peptide (BNP), and peak VO 2 , heart failure hospitalization and cardiovascular death were significantly associated with GLS at rest [hazard ratio (HR) 0.91; 95% confidence interval (CI) 0.84-0.98; P = 0.016], GLS after exercise (HR 0.84; 95% CI 0.77-0.91; P < 0.001), and GLSR after exercise (HR 0.13; 95% CI 0.04-0.48; P = 0.002). The addition of each of the following: exercise GLS and GLSR and resting GLS to the base model including Meta-Analysis Global Group in Chronic Heart Failure, BNP, and peak VO 2 improved predictive power for the study endpoint [net reclassification improvement (NRI) = 49%, P < 0.001; NRI = 42%, P = 0.004; and NRI = 38%, P = 0.009, respectively]. Exercise GLS was the only longitudinal parameter significantly improving c-statistics of the base model (0.68 vs. 0.73; P = 0.047). Conclusions Echocardiographic parameters of LV longitudinal function are not equipotential in predicting adverse outcomes in HFpEF. LV deformation indices, especially assessed with exercise, show the highest predictive utility independent from and incremental to clinical data and BNP.

Diagnostic and Prognostic Value of Global Longitudinal Strain in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

“…In 9 studies, variables such as age, sex, race, history of CV disease, medication history, laboratory tests, and others that might affect the association between LV GLS and research outcomes were adjusted (Table 3). Meta-analyzes with random-effects models showed that the low LV GLS values in HFpEF patients were associated with a higher risk of all-cause death (HR: 1.12; 95% CI: 1.01-1.25; p=0.000, I 2 =84%; P = 0.031)[29,42,44,47,49,51] (Fig 4A), but not with the composite outcomes (all-cause death and HF hospitalization (HR: 1.03; 95% CI: 0.95-1.11; p=0.000, I 2 = 83%; P = 0.51)[29,45–48,51,52] (Fig 4B) or CV death and HF hospitalization (HR: 1.04; 95% CI: 0.94-1.14; p=0.000, I 2 = 81%; P = 0.49)) [6,28,37,41,43] (Fig 4C)). Additionally, three studies by Xu et al, Freed et al, and Kosmala et al reported no association between low LV GLS values in HFpEF patients and the composite outcome of all-cause death and CV hospitalization [40,50,53].…”

Does global longitudinal strain improve stratification risk in heart failure with preserved ejection fraction?

“…On the other hand, we have evaluated the prognostic value of GLS at rest, which does not allow to unmask a decrease in GLS at exercise, an important feature of HFPEF syndrome [20,21]. This was well demonstrated by Wang, et al who found a signi icant association between the GLS of effort, and not of rest, with CV events [22] and by Gozdzik, et al in a recent Australian study [23] Table 4.…”

Diabetic Heart Failure with Preserved Left Ventricular Ejection Fraction: Review of Current Pharmacotherapy

“…As already mentioned, the data for heart failure pharmacotherapy in HFpEF are so far very limited, and no trial has achieved convincing morbidity/mortality endpoints to date. This probably reflects the disease complexity, as there are multiple pathophysiologic mechanisms in HFpEF, such as impaired diastolic function and impaired systolic reserve, impaired longitudinal ventricular systolic and atrial function, impaired autonomic heart function, and peripheral mechanisms such as endothelial and skeletal muscle dysfunction [ 6 , 10 – 13 ]. Now, the question is: “How should we treat patients with DHFpEF?”…”