Left ventricular long-axis performance during exercise is an important prognosticator in patients with heart failure and preserved ejection fraction

Wang, Jing; Fang, Fang; Yip, Gabriel Wai-Kwok; Sanderson, John E.; Feng, Wei; Xie, Jun-Min; Luo, Xiaoting; Lee, Alex; Lam, Yat‐Yin

doi:10.1016/j.ijcard.2014.10.130

Cited by 51 publications

(42 citation statements)

References 29 publications

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“…15 However, before the current publication, limited data were available regarding the prognostic utility in HFpEF patients. 16,17 Shah et al 8 investigated LS in 447 patients with left ventricular EF ≥45% in the echocardiography substudy of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial. Abnormal LS as defined by an absolute value <15.8% was associated with a >2-fold increase in the composite end point of cardiovascular (CV) death, HF hospitalization, or aborted cardiac arrest.…”

Section: Article See P 402mentioning

confidence: 99%

Longitudinal Strain in Heart Failure With Preserved Ejection Fraction

Mentz

Khouri

2015

Circulation

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Section: Article See P 402mentioning

confidence: 99%

Longitudinal Strain in Heart Failure With Preserved Ejection Fraction

Mentz

Khouri

2015

Circulation

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“…A recent meta‐analysis of studies investigating mortality and hospitalizations in patients with diverse cardiac conditions found that GLS independently predicted mortality better than LVEF in almost 6000 patients with HFrEF, acute myocardial infarction, valvular heart disease and cardiac amyloidosis . In patients with chronic HFpEF, GLS has been shown to be a potential predictor of HF related hospitalizations and cardiovascular (CV) death . However, these studies have generally been small, restricted to clinical trial enrollees and excluded patients who were acutely hospitalized with HFpEF.…”

Section: Introductionmentioning

confidence: 99%

Left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: outcomes following an acute heart failure hospitalization

et al. 2017

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AimsWhile abnormal resting LV GLS has been described in patients with chronic heart failure with preserved ejection fraction (HFpEF), its prognostic significance when measured during an acute heart failure hospitalization remains unclear. We assessed the association between left ventricular global longitudinal strain (LV GLS) and outcomes in patients hospitalized with acute HFpEF.Methods and resultsWe studied patients discharged alive for acute HFpEF from Duke University Medical Center between 2007 and 2010. Among patients with measurable LV GLS, we performed 2D, speckle‐tracking analysis and Cox proportional hazards models assessed the association between continuous LV GLS and outcomes. Baseline characteristics were stratified by normal (≤−16%) or abnormal (>−16%) LV GLS for comparison. Among 463 patients, the median LV GLS was −12.8% (Interquartile range, −15.8 to −10.8%) and was abnormal in 352 (76%). Overall patients in the cohort were generally elderly, female and had hypertension. After multivariable adjustment, worse outcomes were noted between LV GLS and mortality (HR 1.19 per 1% increase; 95% CI 1.00–1.42; P = 0.046) and a composite endpoint of mortality or rehospitalization at 30 days (HR 1.08 per 1% increase; 95% CI 0.99–1.18; P = 0.08). There was no association between LV GLS and mortality or a composite of mortality or rehospitalization at 1 year.ConclusionsA high prevalence of patients hospitalized with acute HFpEF have abnormal LV GLS suggesting unrecognized myocardial systolic dysfunction. Furthermore, worse LV GLS is associated with worse clinical outcomes at 30 days but not by1 year.

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“…Importantly, the prognostic value of both abnormal exercise GSR and ExE/e′ were superior to their prognostic value at rest. A further study that evaluated the relative prognostic value of ExE/e′ and post-exercise strain parameters (global longitudinal strain, GLS) was performed by Wang et al in 80 patients with HFpEF who underwent supine bicycle stress ergometry with comprehensive evaluation of rest and post-exercise LV function 38. In this study, abnormal ExE/e′ was a significant predictor of outcomes on univariate analysis, but only abnormal exercise GLS was an independent predictor on multivariate analysis.…”

Section: Haemodynamic Validation Of Exercise E/e′mentioning

confidence: 68%

Diastolic stress echocardiography: from basic principles to clinical applications

Prasad

Holland

Atherton

2018

Heart

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Heart failure with preserved ejection fraction (HFpEF) looms as a major public heart challenge with increasing prevalence due to an ageing population. Diagnosis can be challenging due to non-specific symptomatology, low natriuretic peptide levels and equivocal diastology on resting echocardiography. Diastolic stress echocardiography represents a non-invasive option to refining the diagnosis in this subset of patients. Diastolic responses to exercise are most commonly measured with a non-invasive measure of left ventricular filling pressures (LVFP) estimated by the ratio of the early mitral inflow wave to early diastolic tissue velocity (E/e' ratio). This is measured pre- and post-exercise , and is highly feasible. An elevation of exercise E/e' >15 is classified as an abnormal response as per current guidelines. An alternative measure of exercise-related diastolic performance, the Diastolic Functional Reserve Index has also been proposed, but has not been as well studied as exercise E/e'. A number of studies have validated exercise E/e' as a measure of LVFP against invasively measured LVFP using simultaneous echocardiography-catheterisation studies. The independent prognostic value of exercise E/e' has also been well delineated in a number of studies. While diastolic stress echocardiography can be considered for all patients with suspected HFpEF, it is of particular value in patients with normal or equivocal diastolic indices on resting echocardiography.

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Left ventricular long-axis performance during exercise is an important prognosticator in patients with heart failure and preserved ejection fraction

Cited by 51 publications

References 29 publications

Longitudinal Strain in Heart Failure With Preserved Ejection Fraction

Longitudinal Strain in Heart Failure With Preserved Ejection Fraction

Left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: outcomes following an acute heart failure hospitalization

Diastolic stress echocardiography: from basic principles to clinical applications

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