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Myocardial strain to identify benefit from beta-blockers in patients with heart failure with reduced ejection

Chan Soon Park1, Jin Joo Park2, In-Chang Hwang2

  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

ESC Heart Failure
|January 10, 2022
PubMed

Insights

Beta-blockers improve survival in heart failure patients with reduced ejection fraction (HFrEF) and lower global longitudinal strain (GLS < 10%). However, those with higher GLS (≥ 10%) do not show similar survival benefits from beta-blockers.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Myocardial Mechanics

Background:

  • Beta-blockers are a cornerstone therapy for heart failure with reduced ejection fraction (HFrEF).
  • Individual patient response to beta-blockers varies, suggesting a need for personalized treatment strategies.
  • Global longitudinal strain (GLS), a measure of myocardial deformation, may offer prognostic insights beyond ejection fraction.

Purpose of the Study:

  • To investigate the differential impact of beta-blocker therapy on long-term survival in HFrEF patients based on their baseline global longitudinal strain (GLS).
  • To determine if GLS can identify HFrEF patients who may not benefit from beta-blockers.

Main Methods:

  • Analysis of 2126 HFrEF patients from the "Strain for Risk Assessment and Therapeutic Strategies in Patients with Acute Heart Failure" registry.
  • Patients were stratified into two groups: GLS ≥ 10% and GLS < 10%.
  • Five-year all-cause mortality was assessed in relation to beta-blocker use using inverse probability treatment-weighting and Cox regression analyses.

Main Results:

  • Beta-blocker use was associated with significantly improved 5-year survival in patients with GLS < 10% (HR 0.70, P < 0.001).
  • No significant survival benefit from beta-blockers was observed in patients with GLS ≥ 10% (P > 0.05).
  • Overall, 1399 patients received beta-blockers, and 864 patients died during the 5-year follow-up.

Conclusions:

  • Global longitudinal strain (GLS) may serve as a biomarker to identify HFrEF patients with attenuated benefits from beta-blocker therapy.
  • GLS < 10% identifies patients likely to benefit from beta-blockers, while GLS ≥ 10% suggests a subgroup where benefits are not evident.
  • These findings support the potential role of GLS in tailoring beta-blocker treatment for HFrEF patients.
Abstract

Keywords:
Beta-blockerHeart failure with reduced ejection fractionMortalityMyocardial strainPrognosis

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