Impaired Systolic Function by Strain Imaging in Heart Failure With Preserved Ejection Fraction

By E. Kraigher‐Krainer, A. Shah, D. Gupta, A. Santos, B. Claggett, B. Pieske, M. Zile, A. Voors, M. Lefkowitz, M. Packer and 2 more. Journal of the American College of Cardiology, 2013

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Objectives This study sought to determine the frequency and magnitude of impaired systolic deformation in heart failure with preserved ejection fraction (HFpEF). Background Although diastolic dysfunction is widely considered a key pathophysiologic mediator of HFpEF, the prevalence of concomitant systolic dysfunction has not been clearly defined. Methods We assessed myocardial systolic and diastolic function in 219 HFpEF patients from a contemporary HFpEF clinical trial. Myocardial deformation was assessed using a vendor-independent 2-dimensional speckle-tracking software. The frequency and severity of impaired deformation was assessed in HFpEF, and compared to 50 normal controls free of cardiovascular disease and to 44 age- and sex-matched hypertensive patients with diastolic dysfunction (hypertensive heart disease) but no HF. Among HFpEF patients, clinical, echocardiographic, and biomarker correlates of left ventricular strain were determined. Results The HFpEF patients had preserved left ventricular ejection fraction and evidence of diastolic dysfunction. Compared to both normal controls and hypertensive heart disease patients, the HFpEF patients demonstrated significantly lower longitudinal strain (LS) (−20.0 ± 2.1 and −17.07 ± 2.04 vs. −14.6 ± 3.3, respectively, p < 0.0001 for both) and circumferential strain (CS) (−27.1 ± 3.1 and −30.1 ± 3.5 vs. −22.9 ± 5.9, respectively; p < 0.0001 for both). In HFpEF, both LS and CS were related to LVEF (LS, R = −0.46; p < 0.0001; CS, R = −0.51; p < 0.0001) but not to standard echocardiographic measures of diastolic function (E’ or E/E’). Lower LS was modestly associated with higher NT-proBNP, even after adjustment for 10 baseline covariates including LVEF, measures of diastolic function, and LV filling pressure (multivariable adjusted p = 0.001). Conclusions Strain imaging detects impaired systolic function despite preserved global LVEF in HFpEF that may contribute to the pathophysiology of the HFpEF syndrome. (LCZ696 Compared to Valsartan in Patients With Chronic Heart Failure and Preserved Left-ventricular Ejection Fraction; NCT00887588) (J Am Coll Cardiol 2014;63:447–56) © 2014 by the American College of Cardiology Foundation

Subfields: Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/1821b5d629a4581a9aa9c8bee67b4ffa5f574038

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Citations in the corpus

Assessment of Left Ventricular Function by Echocardiography: The Case for Routinely Adding Global Longitudinal Strain to Ejection Fraction. (2018, background): “Impaired longitudinal systolic function has been demonstrated in HFpEF and asymptomatic diastolic dysfunction by tissue Doppler and strain imaging (56,57).”
How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). (2019, background): “In general, NP levels are higher in patients presenting with acute shortness of breath for cardiac reason or in acute HF, than in patients who have chronic HF.30,31 Of note, our recommendations target stable symptomatic HFpEF, and natriuretic peptide levels can be normal in these patients even with ”
Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. (2016, methodology): “impaired and thus may be used to differentiate between normal and abnormal myocardial function.(66) Although not an index of LV diastolic function, abnormal LV longitudinal systolic function can be detected by measurements of the mitral annular plane systolic excursion using M-mode, tissue Doppler–d”
Myocardial strain imaging: how useful is it in clinical decision making? (2015, background): “Figure 11 is from a study which compared longitudinal and circumferential global strain in patients with manifest HFpEF to hypertensives with diastolic dysfunction without heart failure and a group of normal controls, and found lower longitudinal and circumferential peak strain in HFpEF patients.(59”