Association of strain echocardiography with cardiovascular outcomes in patients with heart failure with preserved ejection fraction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Speckle Tracking Echocardiography (STE) with measurement of Left Ventricular Global Longitudinal Strain (LVGLS) is an important predictor of morbidity and mortality in Heart Failure with Reduced Ejection Fraction (HFrEF), but its prognostic importance in Heart Failure with Preserved Ejection Fraction (HFpEF) is less clear. The purpose of this meta-analysis is to analyze the association between LVGLS and Major Adverse Cardiac Events (MACE) in HFpEF. Methods A literature search was conducted for studies reporting on STE in patients with HFpEF and the association between LVGLS and MACE. The databases queried were Pubmed, Embase, and Web of Science. The search was not restricted to time or publication status. Results A total of 9 studies with 2,082 total patients met inclusion criteria. Among these, 5 studies with 944 HFpEF patients (300 with future MACE, 644 without future MACE) compared baseline mean LVGLS. Mean follow up duration was 28 months (ranging 12–48 months), mean age was 67 years old, 39.4% were male. LVGLS was significantly reduced in patients who eventually had MACE compared to those without MACE on follow-up (MD −2.09, 95% CI −2.17, −2.01, p < 0.01). 4 studies with 1,138 HFpEF patients (676 with impaired LVGLS below cutoff, 462 with unimpaired LVGLS above cutoff) compared all-cause mortality or heart failure hospitalization. Mean follow up was 35 months, mean age was 71 years old, 38.3% were male, and the average LVGLS cutoff was 14. Impaired LVGLS below cutoff was associated with significantly higher risk of MACE (OR 2.13, 95% CI 1.67, 2.72, p < 0.01). Subgroup analysis demonstrated that impaired LVGLS below cutoff was associated with significantly higher risk of both all-cause mortality (OR 2.11, 95% CI 1.40, 2.97, p < 0.01) and heart failure hospitalization (OR 2.16, 95% CI 1.53, 3.06, p < 0.01). Conclusions STE and measurement of LVGLS may represent a useful clinical tool in risk stratification of HFpEF patients at risk for future mortality and adverse cardiac events.