Comparison of left ventricular longitudinal systolic function parameters in the prediction of adverse outcome in...

Area of Science:

• Cardiology
• Echocardiography
• Heart Failure Research

Background:

• Left ventricular (LV) longitudinal systolic function is crucial for cardiac performance.
• Various echocardiographic parameters assess LV function, but their comparative prognostic value in heart failure with preserved ejection fraction (HFpEF) remains unclear.

Purpose of the Study:

• To compare the prognostic significance of different LV longitudinal function parameters at rest and during exercise in patients with HFpEF.
• To determine if these parameters provide incremental predictive value beyond established clinical and biochemical markers.

Main Methods:

• 201 patients with HFpEF underwent resting and exercise echocardiography, measuring mitral annular plane systolic excursion, systolic tissue velocity (s'), global longitudinal strain (GLS), and global longitudinal strain rate (GLSR).
• Prognostic value was assessed for heart failure hospitalization and cardiovascular death over a median follow-up of 48 months.
• Cox regression and reclassification analyses were performed, adjusting for clinical variables, brain natriuretic peptide (BNP), and peak oxygen consumption (VO2).

Main Results:

• Global longitudinal strain (GLS) at rest and during exercise, and GLSR during exercise, were significantly associated with adverse outcomes after multivariable adjustment.
• The addition of exercise GLS and GLSR, and resting GLS, to a base model including clinical factors, BNP, and peak VO2 significantly improved predictive power (Net Reclassification Improvement: 49%, 42%, and 38%, respectively).
• Exercise GLS demonstrated the strongest incremental predictive value, significantly improving the model's c-statistic.

Conclusions:

• Echocardiographic parameters of LV longitudinal function are not equally effective in predicting adverse events in HFpEF.
• LV deformation indices, especially global longitudinal strain (GLS) assessed during exercise, offer the highest predictive utility.
• These exercise-based deformation parameters provide valuable prognostic information incremental to clinical data and BNP levels in HFpEF management.