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Combining echo-derived haemodynamic phenotypes and myocardial strain for risk stratification of chronic heart failure

Frank Lloyd Dini1, Gabriele Pestelli2,3, Nicola Riccardo Pugliese4

  • 1Cardiovascular Unit 1, Cardiac, Thoracic and Vascular Department, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.

European Heart Journal. Cardiovascular Imaging
|July 5, 2022
PubMed

Insights

Left ventricular global longitudinal strain (LV-GLS) can refine risk assessment in heart failure (HF) patients by integrating with hemodynamic profiles. Its prognostic value varies across HF phenotypes, offering the most insight in patients with normal stroke volume index.

Area of Science:

  • Cardiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Echocardiography categorizes heart failure (HF) patients by hemodynamic profiles.
  • The role of left ventricular global longitudinal strain (LV-GLS) in integrating these profiles for risk stratification remains unclear.

Purpose of the Study:

  • To investigate if LV-GLS can enhance the risk stratification of chronic HF patients when combined with echocardiography-derived hemodynamic profiles.
  • To assess the prognostic value of LV-GLS across different hemodynamic phenotypes.

Main Methods:

  • Evaluated 351 chronic HF outpatients with LV ejection fraction <50% and LV-GLS.
  • Classified patients into four hemodynamic phenotypes: normal output-normal filling pressure (NO-NP), normal output-high filling pressure (NO-HP), low output-no RV dysfunction (LO-NRVD), and low output-RV dysfunction (LO-RVD).
  • Assessed right ventricular (RV) function using tricuspid annular plane systolic excursion and RV free-wall longitudinal strain. Primary endpoint: all-cause mortality and HF hospitalization.

Main Results:

  • Prevalence: NO-NP (38%), NO-HP (22%), LO-NRVD (30%), LO-RVD (10%).
  • The hemodynamic model independently predicted outcomes, providing incremental prognostic information over LV ejection fraction.
  • LV-GLS showed a prognostic continuum across phenotypes, with reduced hazard ratios from NO-NP to LO-RVD.

Conclusions:

  • LV-GLS impairment progresses across the spectrum of hemodynamic phenotypes.
  • The prognostic utility of LV-GLS is dependent on the HF patient subgroup.
  • LV-GLS provided the greatest additional prognostic information in patients with normal stroke volume index (SVI).
Abstract

Keywords:
Strainechocardiographyhaemodynamicheart failureoutcomeventricular function

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