Myocardial strain for heart failure with preserved ejection fraction but without diastolic dysfunction

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.