The feasibility and utilization of tissue doppler imaging, longitudinal and circumferential strain and strain rate in the diagnostic accuracy for heart failure with preserved ejection fraction

Abstract

Background: Though Tissue Doppler imaging (TDI) is a sensitive tool in identifying diastolic dysfunction, recent myocardial deformation imaging including longitudinal and circumferential strain and strain rate enabled early detection of subclinical systolic dysfunction. Head-to-head comparison and optimal cut-off by these measures for preserved ejection fraction heart failure (HFpEF) remained elusive. Methods: Echocardiography was performed in 2 groups of hospitalized patients: 1) 64 with HFpEF (EF ≥50%); 2) 240 without clinical evidence of HF. TDI-based mitral annulus systolic (S') and early diastolic (E') velocities were measured as well as global longitudinal (GLS) and circumferential strain (GCS), systolic (S SR)/diastolic strain rate (E SR) from 3 apical views by Echo system. The diagnostic accuracy and optimal cut-off for these parameters were compared. Results: For all HFpEF patients, the sensitivity, specificity, and area under ROC curve (AUROC) for GLS were 68.8%, 86.7%, and 0.85, respectively (Table), with an optimal cut-off set at -16.4%. Longitudinal S SR also had good AUROC (0.74) in HFpEF, while circumferential E' SR was most sensitive (93.7%). The highest positive predictive value and negative predictive value were achieved by GLS (57.9%) and E CSR (92.5%), respectively. Abbreviations: GLS, global longitudinal strain; S LSR, systolic longitudinal strain rate; E LSR, diastolic longitudinal strain rate; GCS, global circumferential strain; S CSR, systolic circumferential strain rate; E CSR, diastolic circumferential strain rate; LFS, longitudinal fractional shortening; PPV, positive predictive value; NPV, negative predictive value. Conclusion: Deformation-based imaging using global longitudinal strain remains a sensitive clinical indicator for identifying subclinical systolic dysfunction in HFpEF, which is more accurate than TDI in our study.