Comparative analysis of myocardial strain parameters in acute decompensated heart failure phenotypes: a
Zhizhou Lin1, Songyuan Yu1,2, Jiajie Yin1
1Department of Integrative Medicine Cardiology, China-Japan Friendship Hospital, Beijing, China.
Objective:
To investigate the differences in two-dimensional speckle tracking echocardiography (2D-STE) parameters among patients with different types of acute decompensated heart failure (ADHF) and their correlation with left ventricular ejection fraction (LVEF).
Methods:
Ninety-eight patients hospitalized due to ADHF were included in this study. Patients were divided into two subgroups based on their LVEF using a cutoff of ≤49%: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). All patients underwent transthoracic echocardiography and 2D-STE.
Results:
Compared to the HFrEF group,the HFpEF group showed significantly higher absolute values of GLSA4C, GLSA2C, GLSA3C, and LV-GLS values (P < 0.05), as well as higher absolute values of LASR-ED, LASRD-ED, LASRT-ED, RVFWSL, and RV4CSL values (P < 0.05). The HFrEF subgroup had higher LAFI and LASI values compared to the HFpEF group (P < 0.05). In the HFrEF subgroup, LVEF was negatively correlated with GLSA4C, GLSA2C, GLSA3C, LV-GLS, RVFWSL, RV4CSL, LASr-ED, LASrct-ED, as well as LAFI and LASI (P < 0.05). However, LVEF was positively correlated with LASrcd-ED (P < 0.05). In the HFpEF subgroup, LVEF was negatively correlated only with GLSA4C, GLSA2C, GLSA3C and LV-GLS (P < 0.05). After controlling for related variables (LVEF), the correlations between LV-GLS and LASr-ED, LASrcd-ED, and LASrct-ED remained significant in both groups of heart failure patients (P < 0.05). In HFrEF patients, the correlations between RVFWSL and LASr-ED, LASrcd-ED, and LASrct-ED disappeared (P > 0.05). In HFpEF patients, RVFWSL was negatively correlated with LASr-ED (P < 0.05), positively correlated with LASrct-ED (P < 0.05), but its correlation with LASrcd-ED disappeared (P > 0.05).
Conclusion:
Significant differences exist in 2D-STE parameters between the HFrEF and HFpEF groups, and LVEF correlates with these parameters. After adjusting for LVEF, LV-GLS remains correlated with various parameters in different heart failure groups. Our findings suggest a stronger interdependence between right ventricular and left atrial mechanics in HFpEF patients compared to HFrEF patients, evidenced by the persistence of correlations between RV free wall strain and LA reservoir/pump strain after adjusting for LVEF.
