Long term prognostic value of global myocardial work in patients with heart failure with mildly reduced ejection fraction

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) is defined as HF with a left ventricular (LV) ejection fraction (LVEF) of 41–49%. However, the change in LV function and the subsequent prognosis in these patients remain unclear. Echocardiographic global longitudinal strain (GLS) is a useful measure for detection of myocardial function but is influenced by blood pressure changes. In contrast, myocardial work (MW), incorporating blood pressure, may overcome the limitation. Objectives We aimed to investigate whether LV MW could differentiate the changes of LVEF and predict the clinical outcomes in patients with HFmrEF. Methods In this prospective cohort study, 273 outpatients with HFmrEF underwent echocardiograms at diagnosis and one year after HF therapies. GLS, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency were measured. The observed clinical outcome was hospitalizations for HF. Regression analysis was used to study the combined use of GLS and MW for the diagnostic and prognostic assessment of HFmrEF. Results Among patients with HFmrEF, the more impaired the LV GLS at baseline, the higher probability of worsening EF development. An absolute change in GLS and GWI were associated with subsequent worsening EF. Change in GWI and GCW demonstrated incremental value over GLS and clinical factors for the diagnosis of concurrent worsening EF. Regarding the clinical outcome, patients who presented with worsening EF had a higher risk of hospitalization for HF. In Cox regression, patients with more preserved GLS or lesser GLS decline during the follow-up had a lower risk of hospitalization for HF. Notably, the combined use of GLS and MW add incremental value on the prognosis in patients with HFmrEF. Conclusions GLS can be used for differentiating the changes of LVEF and subsequent hospitalization for HF in patients with HFmrEF while MW added predictive values.