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The predictive value of global longitudinal strain in patients with heart failure mid-range ejection fraction
Wei-Ting Chang1, Chih Hsien Lin2, Chon-Seng Hong2
1Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
Insights
Left ventricular global longitudinal strain (LV GLS) predicts changes in ejection fraction (EF) and cardiovascular death risk in heart failure with mid-range EF (HFmrEF). Impaired LV GLS indicates a higher risk of worsening EF and mortality in HFmrEF patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Heart failure with mid-range ejection fraction (HFmrEF) encompasses patients with left ventricular ejection fraction (LVEF) between 41-49%.
- Prognostic indicators and the natural progression of LV function in HFmrEF remain incompletely understood.
- The utility of LV global longitudinal strain (LV GLS) in predicting outcomes for HFmrEF patients requires further investigation.
Purpose of the Study:
- To assess if LV GLS can differentiate changes in LVEF over time.
- To determine the predictive value of LV GLS for clinical outcomes in HFmrEF.
- To identify potential prognostic markers for HFmrEF.
Main Methods:
- 273 HFmrEF outpatients were categorized based on LVEF changes during follow-up: HF with worse EF (HFwEF), HF with similar EF (HFsEF), and HF with recovered EF (HFrecEF).
- Baseline LV GLS was measured using echocardiography.
- Patient outcomes, including hospitalization for HF and cardiovascular death, were monitored over an average of 31 months.
Main Results:
- A more impaired baseline LV GLS was associated with a higher likelihood of developing HFwEF.
- Patients achieving HFrecEF demonstrated a reduced risk of HF hospitalization compared to those in HFwEF and HFsEF groups.
- LV GLS at a cutoff of -11% effectively predicted cardiovascular death risk, with values >-11% indicating high risk.
Conclusions:
- LV GLS is a valuable marker for predicting LVEF trajectory and cardiovascular mortality in HFmrEF.
- Achieving recovered EF (HFrecEF) is linked to a lower risk of HF hospitalization.
- LV GLS measurement can aid in risk stratification and management strategies for HFmrEF patients.
Background:
Heart failure (HF) with mid-range ejection fraction (HFmrEF) is defined as HF with a left ventricular (LV) ejection fraction (LVEF) of 41-49%. However, the change in LV function and the subsequent prognosis in these patients remain unclear. We aimed to investigate whether LV global longitudinal strain (LV GLS) could differentiate the changes in LVEF and predict the clinical outcomes in patients with HFmrEF.
Methods:
According to the changes in LVEF on follow-up echocardiography, 273 outpatients with HFmrEF were divided into 3 groups: HFwEF (HF with worse EF: <40%), HFsEF (HF with similar EF: 40-49%), and HFrecEF (HF with recovered EF: >50%). Further, the LV GLS at diagnosis was evaluated.
Results:
The average follow-up duration was 31 months. Among patients with HFmrEF, the more impaired the LV GLS at baseline, the higher probability of HFwEF development. In comparison with patients with HFwEF and HFsEF, those with HFrecEF had a lower risk of hospitalization for HF. At a cut-off value of -11%, LV GLS differentiated the subsequent risk of cardiovascular death in patients with HFmrEF. In Cox regression, patients with LV GLS >-11% had a high risk of cardiovascular death.
Conclusion:
In patients with HFmrEF, LV GLS is associated with LVEF changes and subsequent cardiovascular death. Patients with HFrecEF had a lower risk of hospitalization for HF.
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