Phenotyping Acute Decompensated Heart Failure (ADHF)by a cardiac speckle tracking analysis

Abstract

Abstract Background The global longitudinal strain (GLS) evaluation by Speckle Tracking Echocardiography (STE) is an established non-invasive, highly reproducible echocardiographic prognostic index in Heart Failure (HF). In acute decompensated heart failure (ADHF), GLS has proved to have greater prognostic value than left ventricular ejection fraction (LVEF) in the categorization of HF. However, how GLS may change over hospital staying in ADHF and how it correlates with Left Atrial (LA) functioning and contractile reserve in this cohort of subjects is currently undefined. Aims To evaluate, in a cohort of ADHF patients, GLS extent of changes after targeted anti-congestion therapy and its correlation with LA mechanics and reservoir function. Methods Eighty-five ADHF patients (mean age 75.6±10.4 years, 59% males) were prospectively enrolled within 24 hours from admission to the emergency department (ED). In either the acute phase and at pre-discharge all patients underwent laboratory tests, Lung Ultrasonography (LUS), M-Mode, 2-Dimensions and Doppler Echocardiography. LA dynamics assessment was based on the evaluation of LA strain, particularly through Global-Peak Atrial Longitudinal Strain (GPALS). Strain analysis by STE was performed offline. Results From admission to discharge, despite decongestion as shown by a significant reduction of the number of B-lines measured at LUS and NT-proBNP at blood tests (B-lines: 22.2±17.1 vs. 6.5±5 p<0.001; NT-proBNP: 8738±948 ng/l vs 4227±659 ng/l p<0.001), we observed only minimal and non-significant changes in the average GLS (from −12.2±4% at admission to −12.5±3.8% at discharge; p=0.8) and GPALS (from 13.2±7.6% at admission to 13.6±7.8% at discharge; p=0.77) (Table 1). Interestingly, when evaluated with Pearson's coefficient, in the whole population a significant direct correlation was observed between GLS and GPALS values at discharge (r=0.6, 95% Confidence Interval (CI) 0.55–0.7; p<0.001) (Figure 1) as well as between ΔGLS and ΔGPALS (r=0.42 95% CI 0.21–0.59, p=0.02). Conclusions In patients hospitalized for ADHF a significant impairment of GLS occurs and no improvement is observed at discharge after decongestion. The LA dynamics correlates with, and is likely involved in, this lack of changes. In this subset of patients, the dissociation between decongestion and LV and LA dynamics evaluated by strain analysis suggest the importance to monitor these functional indicators in order to improve risk stratification and reduce early re-hospitalization for AHF. Funding Acknowledgement Type of funding sources: None.