Assessment of GLS using a semiautomated algorithm provides important prognostic information in patients with LVEFs >40% above and beyond traditional indexes of high-risk MI.

Mechanical dispersion by strain echocardiography predicted arrhythmic events independently of LVEF in this prospective, multicenter study of patients after MI. A combination of mechanical dispersion and global strain may improve the selection of patients after MI for implantable cardioverter-defibrillator therapy, particularly in patients with LVEFs >35% who did not fulfill current implantable cardioverter-defibrillator indications.

AimsHeart failure (HF) is increasingly prevalent among the growing number of elderly people, but not well studied. We sought to evaluate disease pattern and importance of prognostic factors among very elderly patients with HF. Methods and resultsAmong 8507 patients screened for entry into two studies on HF, we analysed the clinical characteristics, major comorbidities and prognostic factors in 825 patients older than 85 years (very elderly) compared with younger age groups. Adjusted hazard ratios [HR (95% confidence intervals)] of long-term mortality were calculated using Cox models. The very elderly were more often female (60 vs. 26%) and had a higher prevalence of preserved ejection fraction (53 vs. 36%) compared with patients younger than 65 years (P , 0.001). The prevalence of cardiovascular comorbidities increased with advancing age only until the seventh decade and then declined, resulting in the lowest prevalence of diabetes (12 vs. 16%, P , 0.001), hypertension (20 vs. 26%, P , 0.001), ischaemic heart disease (42 vs. 53%, P , 0.001), and peripheral artery disease (4 vs. 6%, P ¼ 0.017) among the very elderly compared with patients aged ,85 years. Non-cardiovascular comorbidities generally increased linearly with age. Long-term mortality was associated with atrial fibrillation [HR ¼ 1.30 (1.06-1.60), P ¼ 0.013] with greater prognostic importance in the very elderly, while ejection fraction, diabetes [HR ¼ 1.31 (1.01-1.61), P ¼ 0.04], and renal insufficiency [HR ¼ 1.36 (1.13-0.63), P , 0.0001] had less prognostic importance than in younger patients (P for interactions ,0.003). ConclusionThe prevalence of cardiovascular comorbidities is lower in very elderly HF patients and has different prognostic importance.--

Background While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Methods and Results Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction≥50%) in whom 2-dimensional, speckle-tracking LV GLS was possible (n=187) were analyzed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was −14.6% (25th, 75th percentile, −17.0%, −11.9%) and abnormal (≥−16%) in 122/187 (65%). Patients in the tertile with the best LV GLS had lower NT-proBNP (median 505 pg/mL [161, 1065] vs 875 pg/mL [488, 1802], p=0.008) and lower PIIINP levels (median 6.7 ug/L [5.1, 8.1] vs 8.1 ug/L [6.5, 10.5] p=0.001) compared to the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r=0.29, p<0.001 and r=0.19, p=0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with HF scores, 6 minute walk distance, peak VO2, or VE/VCO2 slope. Conclusions Impaired LV GLS is common among HFpEF patients indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity suggesting other processes may be more responsible for these aspects of the HFpEF syndrome. Clinical trial registration www.clinicaltrials.gov (unique dentifier: NCT00763867)

Deformation-based E/e'sr contributes important information about global myocardial relaxation superior to velocity-based analysis and is independently associated with the outcome in acute MI.