Speckle tracking parameters in the two genders in chronic heart failure: a multicentric italian study

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Abstract Introduction the incidence of heart failure (HF) with reduced ejection fraction (EF, HFrEF) and with mildly reduced EF (HFmrEF) is globally lower worldwide and women are underrepresented in clinical trials. A deeper knowledge of possible gender differences in HF is needed to guarantee a better management. Purpose to evaluate left (LV) and right ventricular (RV) and left atrial (LA) longitudinal deformation by speckle tracking echocardiography (STE) in a population of patients with HF and ejection fraction (EF) <50%, to describe possible gender differences. Methods we retrospectively enrolled patients from 7 different Italian centers, referred to a high experience echocardiographic laboratory for stable chronic HF follow up. We excluded patients with preserved LV ejection fraction, recent admission for acute HF, previous cardiac surgery, and absent informed consent. All patients underwent complete standard and advanced echocardiography, including STE-derived LV, RV and LA strain. Kolmogorov-Smirnov test was used to verify normal distribution of variables. Continuous variables were compared using the unpaired t test for normally distributed variables and the nonparametric Mann-Whitney U test for non-normally distributed variables. Results a multicentric population of 644 patients (mean age 66.8±11.4, 237 female, 37%) was finally included in the study. The population had a globally reduced systolic function (mean LVEF 33.4±9.7%, mean LV global longitudinal strain (GLS) -9.7±3.5%) with abnormal RV longitudinal deformation (mean free wall RVLS -17.6±6.1%), increased pulmonary pressures (sPAP 35.1±12 mmHg) and diastolic disfunction (LA strain (PALS) was 16.3±8%, mean E/e’ ratio 12.2±3.6). Analyzing the female population with HF (see Table 1), women had lower LV and RV mass and diameters. The LA was smaller, but they had similar diastolic indices compared to man. Interestingly, deformation analysis revealed comparable LV, LA, and RV longitudinal strain in the two genders. Conclusion female HF population seems to have similar cardiac longitudinal dysfunction compared to men. It could be then credible to expect similar therapeutic response to HF drugs in the two genders. Further studies are needed to evaluate different echocardiographic prognostic parameters across gender in HFrEF and HFmrEF.