Left ventricular strain-volume loops and diastolic dysfunction in suspected heart failure with preserved ejection...

Area of Science:

• Cardiology
• Medical Imaging
• Physiology

Background:

• Left ventricular diastolic dysfunction (DD) is crucial in heart failure with preserved ejection fraction (HFpEF) pathogenesis.
• Current non-invasive assessments of diastolic function are complex and rely on consensus guidelines.
• Novel imaging techniques are needed for improved DD detection.

Purpose of the Study:

• To compare left ventricular strain-volume loop (SVL) characteristics in patients with suspected HFpEF.
• To evaluate the association between SVL parameters and diastolic (dys-)function.
• To explore novel non-invasive methods for assessing diastolic function.

Main Methods:

• Prospective inclusion of 257 patients with suspected HFpEF and sinus rhythm during echocardiography.
• Analysis of 211 patients with quality-controlled images, strain, and volume data.
• Classification into normal diastolic function (n=65) and DD (n=91) groups based on 2016 ASE/EACVI recommendations, excluding indeterminate cases.

Main Results:

• Patients with DD were older, more frequently female, and had higher rates of atrial fibrillation and hypertension.
• Strain-volume loop (SVL) analysis revealed significant uncoupling (altered longitudinal strain contribution to volume change) in the DD group (0.556 ± 1.10% vs. -0.051 ± 1.14%, P < 0.001).
• An adjusted odds ratio of 1.68 (95% CI 1.19-2.47) indicated that SVL uncoupling was independently associated with DD.

Conclusions:

• Strain-volume loop (SVL) uncoupling is an independent predictor of diastolic dysfunction (DD).
• This finding provides novel insights into cardiac mechanics during the cardiac cycle.
• SVL analysis presents a promising non-invasive approach for assessing diastolic function in HFpEF.