Abstract 14852: Association Between Features of Adverse Myocardial Function Beyond Ejection Fraction and Outcomes in Heart Failure With Preserved Ejection Fraction

Abstract

Background: Heart failure (HF) guidelines recommend assessment of left ventricular ejection fraction (LVEF) to classify patients and guide therapy implementation. However, LVEF alone may be insufficient to adequately characterize patients with HF with mildly reduced or preserved LVEF. Recommendations on additional testing are lacking, and echocardiographic features beyond LVEF are relatively under-investigated in the real-world HFpEF population despite their ubiquity in clinical practice. Methods: Using an echocardiographic and clinical database from a large US healthcare system, patients with HFpEF were defined as those with LVEF>40% and at least one distinct billing diagnosis of acute or chronic HF. The association of the following metrics with mortality was evaluated: global longitudinal strain (GLS>-16), left atrial volume (LAVi>28), left ventricular hypertrophy (LVH), and E/e’>13 & e’<9. A multivariable model for mortality was constructed including age, sex, and key co-morbidities followed by stepwise selection of echocardiographic features. Results: Among 2,337 patients with complete echocardiographic data, the following features were associated with all-cause mortality over 3 years of follow-up: E/e’ + e’, GLS, LAVi (all p<0.01). In the multivariable model (c-index=0.65), only GLS was independently associated with all-cause mortality (HR 1.35 [1.11-1.63], p=0.002). In the setting of normal LVEF (>55%), 498 patients (39.7%) demonstrated decreased GLS. This cohort demonstrated higher event rates compared to patients with normal GLS irrespective of LVEF ( Figure, Panel A-B ). Conclusions: In a large, real-world HFpEF population, echocardiographic features of HFpEF, led by GLS, are associated with adverse outcomes irrespective of LVEF. A large subset of patients demonstrate adverse myocardial function by GLS despite preserved LVEF and may represent a key cohort of interest for therapy implementation and future clinical studies.