Multilayer myocardial strain improves the diagnosis of heart failure with preserved ejection fraction

Abstract

Aims The diagnostic and treatment of patients with heart failure with preserved ejection fraction (HFpEF) are both hampered by an incomplete understanding of the pathophysiology of the disease. Novel imaging tools to adequately identify these patients from individuals with a normal cardiac function and respectively patients with HF with reduced EF are warranted. Computing multilayer myocardial strain with feature tracking is a fast and accurate method to assess cardiac deformation. Our purpose was to assess the HFpEF diagnostic ability of multilayer strain parameters and compare their sensitivity and specificity with other established parameters. Methods and results We included 20 patients with a diagnosis of HFpEF and, respectively, 20 matched controls. We assessed using feature-tracking cardiac magnetic resonance longitudinal and circumferential myocardial strain at three distinct layers of the myocardium: subendocardial (Endo-), mid-myocardial (Myo-), and subepicardial (Epi-). Comparatively, we additionally assessed various others clinical, imaging, and biochemical parameters with a putative role in HFpEF diagnostic: left ventricular end-diastolic volume (LVEDV), left ventricular mass (LVM), interventricular septum (IVS) wall thickness and free wall thickness, left atrial volume and strain, septal and lateral mitral annular early diastolic velocity (e`), E/e´ratio, and plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP). Global longitudinal strain (GLS) is significantly impaired at Endo (À20.8 ± 4.0 vs. À23.2 ± 3.4, P = 0.046), Myo-(À18.0 ± 3.0 vs. À21.0 ± 2.5, P = 0.002), and Epi-(À12.2 ± 2.0 vs. À16.2 ± 2.5, P < 0.001) levels. Compared with any other imaging parameter, an Epi-GLS lower than 13% shows the highest ability to detect patients with HFpEF [area under the curve (AUC) = 0.90 (0.81-1), P < 0.001] and in tandem with NT-proBNP can diagnose with maximal sensibility (93%) and specificity (100%), patients with HFpEF from normal, composed variable [AUC = 0.98 (0.95-1), P < 0.001]. In a logistic regression model, a composite predictive variable taking into account both GLS Epi and NT-proBNP values in each individual subject reached a sensitivity of 89% and a specificity of 100% with an AUC of 0.98 (0.95-1), P < 0.001, to detect HFpEF. Conclusions Epi-GLS is a promising new imaging parameter to be considered in the clinical assessment of HFpEF patients. Given its excellent specificity, in tandem with a highly sensitive parameter such as NT-proBNP, Epi-GLS holds the potential to greatly improve the current diagnostic algorithms.

The year in cardiovascular medicine 2020: heart failure and cardiomyopathies

“…20 Ipak, velik broj nejasno definiranih bolesnika čini kliničke odluke zahtjevnima. 21 Analiza mehanike LA, naprezanja LA i globalnoga longitudinalnog naprezanja (GLS) lijeve klijetke (LV) 22 omogućuje bolju klasifikaciju stupnja dijastoličke disfunkcije i poboljšava individualnu stratifikaciju rizika. Dva algoritma (H2FPEF i ESC HFA-PEFF) mogu olakšati postavljanje dijagnoze HFpEF-a.…”

“…24 Parameters of LV mechanics (LV strain, multilayer strain and myocardial work) provide incremental prognostic information over LVEF. 22,25 The benefit of treatment [i.e. sacubitril/valsartan (SV)] on LV remodelling is also better captured by LV strain.…”

Direct comparison of multilayer left ventricular global longitudinal strain using CMR feature tracking and speckle tracking echocardiography

“…Endocardial GLS was also shown to be disproportionately affected in NSTEMI patients compared to epicardial strain and LVEF, and is a superior index in identifying significant coronary artery disease [ 10 ]. A recent study by Tanacli et al established CMR-FT derived epicardial GLS along with NT-proBNP as a viable composite predictive tool in the diagnosis of HFpEF with excellent specificity and sensitivity [ 22 ]. NT-proBNP alone has limitations in detecting early HFpEF and cannot reliably discriminate between HFpEF and HFrEF.…”

Myocardial deformation assessed among heart failure entities by cardiovascular magnetic resonance imaging

“…The detailed inclusion and exclusion criteria are listed on the webpage of the DRKS. Further analyses of this study have already been published 13–16 …”

“…Further analyses of this study have already been published. [13][14][15][16] Cardiac magnetic resonance All CMR images were acquired using 1.5 T (Achieva, Philips Healthcare, Best, The Netherlands) magnetic resonance imaging (MRI) scanners with a five-channel cardiac surface coil in a supine position. All study participants were scanned using identical comprehensive imaging protocol.…”