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Updated: Sep 5, 2025
Magnetic Resonance Derived Myocardial Strain Assessment Using Feature Tracking
Published on: February 12, 2011
Myocardial strain for heart failure with preserved ejection fraction but without diastolic dysfunction
Jin Joo Park1, In-Chang Hwang1, Si-Hyuck Kang1
1Cardiovascular Center and Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Insights
Patients with heart failure (HF) and preserved ejection fraction (HFpEF) but no diastolic dysfunction may have impaired myocardial strain. Impaired global longitudinal strain (GLS) indicates HF and predicts higher mortality.
Area of Science:
- Cardiology
- Cardiovascular Research
- Heart Failure Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) presents diagnostic challenges, particularly when diastolic dysfunction is not significant.
- Natriuretic peptides (NPs) and ejection fraction (EF) alone are insufficient for definitive HF diagnosis in some patients.
- Myocardial strain analysis offers prognostic insights in cardiovascular conditions.
Purpose of the Study:
- To investigate the prognostic value of global longitudinal strain (GLS) in patients with apparent heart failure (HF) and preserved ejection fraction (EF ≥50%) but without significant diastolic dysfunction.
- To determine if impaired GLS identifies a subgroup of patients with HFpEF who have worse outcomes.
- To compare the long-term survival of these patients with age- and sex-matched controls.
Main Methods:
- Retrospective analysis of 355 patients with acute HF, EF ≥50%, elevated NPs, and no significant diastolic dysfunction.
- Classification of patients into impaired GLS (<16%) and normal GLS (≥16%) groups.
- Primary endpoint: 5-year all-cause mortality, compared between GLS groups and with controls.
Main Results:
- Overall 5-year mortality was 30.1%.
- Patients with impaired GLS (49.6%) had significantly higher 5-year mortality compared to those with normal GLS (P < 0.001).
- Impaired GLS was associated with a 48% increased risk of all-cause mortality versus controls (HR 1.48).
Conclusions:
- Impaired GLS identifies patients with apparent HF and preserved EF (without diastolic dysfunction) who have a worse prognosis.
- Myocardial strain assessment, specifically GLS, is crucial for diagnosing and risk-stratifying patients with HFpEF.
- Normal GLS in this cohort is associated with long-term survival comparable to the general population.
Aims:
Some patients with apparent heart failure (HF) have an ejection fraction (EF) ≥ 50% and elevated levels of natriuretic peptides (NPs), but no significant diastolic dysfunction. Among these, some may have HF, others may not. Myocardial strain is an excellent prognostic factor.
Methods And Results:
Among 4312 consecutive patients with acute HF from three tertiary hospitals, we included 355 patients with EF of ≥50% and elevated levels of NPs, without significant diastolic dysfunction. Patients were classified as having impaired global longitudinal strain (GLS < 16%) or normal GLS (GLS ≥ 16%). The primary endpoint was 5 year all-cause mortality. The mean age was 70.3 years and 49% were female. Overall, 107 patients (30.1%) died at 5 years. As per the definition, 176 (49.6%) patients had impaired GLS and 179 (50.4%) had normal GLS. Patients with normal GLS had lower 5 year all-cause mortality than those with impaired GLS (P < 0.001). When comparing with the 11 365 age-matched and sex-matched controls, patients with normal GLS had the same long-term survival as the controls (P = 0.834), whereas those with impaired GLS had 48% increased risk of all-cause mortality (hazard ratio, 1.48; 95% confidence interval, 1.17-1.89).
Conclusions:
Among patients with apparent HF and preserved EF but without diastolic dysfunction, those with impaired GLS may be considered to have HF.
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