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Abstract
Objectives: To assess the association between abnormal left ventricular global longitudinal strain (LV GLS) and outcomes in patients hospitalized with acute heart failure with preserved ejection fraction (HFpEF). Methods: Patients discharged alive from Duke University Medical Center between 2007 and 2010 following admission for acute HFpEF who had an echocardiogram with left ventricular ejection fraction ≥50% during the admission comprised the analysis cohort. We performed 2-dimensional, speckle-tracking analysis and stratified the cohort by LV GLS as normal (≤-16%) or abnormal (>-16%). Cox proportional hazards models assessed the association between continuous LV GLS and outcomes. Results: We identified 545 consecutive patients with measurable LV GLS. The median LV GLS was -12.6% (25 th -75 th percentile, -15.5% to -10.6%) and 424 (78%) had abnormal LV GLS. Patients with abnormal LV GLS had higher levels of NT-proBNP (2548 vs. 1522 pg/mL, p=0.02) compared to those with normal LV GLS. There was no statistically significant association between LV GLS and mortality through 5 years (adjusted HR 1.02 per 1% increase; 95% CI: 0.98 to 1.06; p=0.33) or mortality and hospitalization (adjusted HR 1.02 per 1% increase; 95% CI: 0.99 to1.06; p=0.25) ( Figure ). A similar trend was seen between LV GLS and mortality and hospitalizations at 30 days (adjusted HR 1.08 per 1% increase; 95% CI: 1.00 to1.16; p=0.06) and 1 year (adjusted HR 1.04 per 1% increase; 95% CI: 1.00 to1.09; p=0.08). Conclusions: Using a cutoff value for LV GLS of -16%, a high prevalence of patients with acute HFpEF have abnormal LV GLS suggesting covert myocardial systolic dysfunction. However, LV GLS was not associated with mortality after accounting for traditional risk factors. Further studies are necessary to understand the role for LV GLS in routine clinical practice for HFpEF patients.
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