Prognostic capacity of deformability analysis through speckle tracking by echocardiography in heart failure

Abstract

Introduction and Objectives: Bidimensional speckle tracking (ST-2D) enables the quantitative assessment of the left ventricle deformation. This study was aimed to assess discriminative and prognostic value of the left ventricle myocardial deformation analysis (MDA) in patients with heart failure (HF) irrespective ejection fraction. Methods: Patients were included during admission for decompensated HF. After clinical stabilization, MDA by 2D-echocardiography was performed. Patients were followed up for 180 days. Differences in MDA profiles were compared between reduced (HF with reduced EF [HFrEF]) and preserved (HF with preserved EF [HFpEF]) EF. An additional prospective follow-up cohort analysis to assess prognostic value of MDA was carried out. End point was a composite of death, non-scheduled emergency visits, and readmissions. Results: We included 101 patients, 57 (56.4%) with EF > 50%. Fourteen patients (13.9%) died during follow-up; 31 were readmitted (30.7%); and 17 (16.7%) had unscheduled emergency visits. Global systolic circumferential strain rate (SR) had the highest prognostic value. There was an association between a SR below the median (−1.56 cm/s) and unfavorable development (odds ratio [OR] 2.31, confidence interval at 95% [CI 95%] 1.34-3.96, p = 0.002). In patients with HFrEF, an NT-proB-NP above the median and SR below the median the OR for events during follow-up were 2.85 (CI 95% 1.15-9.25, p = 0.042), while in HFpEF were 1,778 (CI 95% 1.13-3.65, p = 0.022). Conclusions: In patients with HF, MDA, especially global circumferential SR, is predictive of adverse events during follow-up and combined with NT-proBNP improves risk stratification irrespective of EF phenotype. Furthermore, MDA can be useful for refining classification of patients with HF and intermediate EF range.