Introduction: Increased B-type Natriuretic Peptide (NT-proBNP) levels have been associated with adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Global longitudinal strain (GLS) and wall stress (WS) are frequently reported to be abnormal in these patients as well, but studies examining how structural changes in those with HFpEF affect morbidity and mortality have been scarce. Hypothesis: NT-proBNP is a stronger predictor of death and heart failure readmissions in HFpEF patients when compared to GLS and WS. Methods: We conducted a retrospective study of 237 patients admitted with acute decompensated heart failure, all with EF > 50. Average age was 78 + 11, 69% of patients were female, and average BMI was 29 + 13. GLS was measured using speckled tracing echocardiography and WS was calculated from systolic blood pressure, end-systolic left ventricular (LV) dimension, and end-systolic posterior wall thickness. Results: During a follow-up period of 2 years, 55 patients died and 55 were readmitted with the diagnosis of acute decompensated heart failure. Mean NT-proBNP among all patients was 9982 + 16268, mean GLS -17.84 + 4.52, and mean WS was 52.27 + 25.23. 129 patients had an abnormal or borderline GLS of >-18, whereas nearly all patients (230) had an abnormal WS of <109. (See table for results.) Conclusion: GLS and WS are reduced in a significant proportion of HFpEF patients. However, our data suggests that compared to echocardiographic indices of LV systolic function, biomarkers have a stronger short-term prognostic value.

Introduction: Stress cardiomyopathy (SC) and anterior ST elevation myocardial infarction (AMI) share similar clinical and echocardiographic features on initial presentation, complicating their differentiation. Previously, subtle differences in 12-lead ECG between the two have been reported. Hypothesis: We propose that higher precordial R-wave amplitude on ECG and lower biomarkers values can serve as reliable predictors of SC during initial triage. Methods: Among patients admitted to a single center from 2015-2019 undergoing left heart catheterization (LHC) for suspected AMI, 76 patients with either LHC-proven SC or AMI (38 each) were included. All patients had transthoracic echocardiography (TTE) performed within 24 hours of LHC. Patients were excluded when TTE quality was poor. Left ventricular ejection fraction (LVEF) and speckle-tracking global longitudinal strain (GLS) were calculated from transthoracic apical views. Non-parametric variables were analyzed using Wilcoxon rank sum test. Sensitivity and specificity analyses were performed using ROC curves. Results: LVEF (33 + 9% vs 33 + 8%) and GLS (-7.5 + 2.8% vs -7.9 + 3.3%) were similar in both groups. R-wave amplitude in ECG leads V1-V2 was higher in SC compared to AMI (V1: 0.96 vs 0.54 mV, p = 0.035; V2: 1.46 vs 0.75 mV, p = 0.037). At index admission, peak pro-BNP was higher (22198 vs 3098, p = 0.002) and peak Troponin-T (1.43 vs 236, p <0.001) was lower in SC. Integrating peak Troponin-T and V1+V2 R-wave amplitudes differentiated SC from AMI with sensitivity = 92% and specificity = 73%. Conclusions: Despite having similar extent of LV systolic dysfunction when compared to AMI patients, SC patients have lower troponin elevation and R-wave amplitude reduction at presentation. These characteristics may be useful for selecting patients who do not require urgent invasive diagnostic evaluation.

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