Contribution of Global and Regional Longitudinal Strain for Clinical Assessment of HFpEF in Coronary and Hypertensive Patients

Abstract

Background: Contribution of global and regional longitudinal strain (GLS) for clinical assessment of patients with heart failure with preserved ejection fraction (HFpEF) is not well established. We sought to evaluate subclinical left ventricular dysfunction secondary to coronary artery disease (CAD) in HFpEF patients compared with hypertensive patients and age-matched healthy subjects. Material and methods: This was a retrospective study that included 148 patients (group 1 = 62 patients with HFpEF, group 2 = 46 hypertensive patients, and group 3 = 40 age-matched control subjects). Peak systolic segmental, regional (basal, mid, and apical), and global longitudinal strain were assessed for each study group using two-dimensional speckle-tracking echocardiography (2D-STE). Results: GLS values presented statistically significant differences between the three groups (p < 0.001); markedly increased values (more negative) were observed in the control group (−20.2 ± 1.4%) compared with HTN group values (−18.4 ± 3.0%, p = 0.031) and with HFpEF group values (−17.6 ± 2.3%, p < 0.001). The correlation between GLS values and HTN stages was significant, direct, and average (Spearman coefficient rho = 0.423, p < 0.001). GLS had the greatest ability to detect patients with HFpEF when HFpEF + CAD + HTN diastolic dysfunction (n = 30) + CON diastolic dysfunction (n = 2) from HFpEF + CAD + HTN + CON was analyzed. (optimal GLS limit of −19.35%, area under curve = 0.833, p < 0.001). Conclusions: Global longitudinal strain can be used for clinical assessment in differentiating coronary and hypertensive patients at higher risk for development of systolic dysfunction.

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

“…Six studies[20,23,27,31–33] estimated the diagnostic usefulness of LV GLS values in HFpEF compared with healthy controls, with LV GLS cut-off values ranging from -16% to -24.1 and AUC from 0.68 to 0.98 (Table 2). Five trails provided complete data for diagnostic meta-analysis (SEN, SPN, TP, FP, FN, and TN).…”

Assessing cardiac contractility in hypertension with heart failure with preserved ejection fraction: the value of left ventricular strain

“…The initial search produced 103 studies and with one identified through other sources, 104 studies were screened and then relevant studies were assessed and evaluated for inclusion (Figure 1). Eight studies were included for quantitative synthesis (Table 1) [17,[19][20][21][22][23][24][25][26]. Excluded were studies that focused on HFpEF in animal models [23].…”

Usefulness of Longitudinal Strain to Assess Cancer Therapy-Related Cardiac Dysfunction and Immune Checkpoint Inhibitor-Induced Myocarditis

“…GLS is widely used in the field of cardiology generally, where it has demonstrated value in detecting subtle myocardial dysfunction, diagnosing disease, predicting disease progression, and allowing for early pharmacological intervention. GLS has demonstrated its usefulness in a number of cardiac diseases, including cardiomyopathy, myocardial infarction, HF, hypertension, and acute coronary syndrome [ 31 , 32 , 33 , 34 ]. Correlations between GLS and deleterious myocardial changes, prognostic predictors, and cardiovascular outcomes have been established in various diseases [ 31 , 32 , 33 , 34 , 35 , 36 ].…”

“…GLS has demonstrated its usefulness in a number of cardiac diseases, including cardiomyopathy, myocardial infarction, HF, hypertension, and acute coronary syndrome [ 31 , 32 , 33 , 34 ]. Correlations between GLS and deleterious myocardial changes, prognostic predictors, and cardiovascular outcomes have been established in various diseases [ 31 , 32 , 33 , 34 , 35 , 36 ]. Therefore, it is not surprising that GLS assessment is recommended in the current cardio-oncology guidelines of the European Society of Cardiology [ 18 ].…”