Global longitudinal strain predicts clinical outcomes in patients with heart failure with preserved ejection fraction

Abstract

AimsPatients with heart failure with preserved ejection fraction (HFpEF) are at high risk for hospitalization and mortality and many of these patients experience a deterioration in left ventricular ejection fraction (LVEF) over time. Global longitudinal strain (GLS) is a sensitive marker of myocardial dysfunction that could help predict risk for future events in this population. We assessed whether GLS can predict adverse clinical outcomes and future deterioration in LVEF in patients with HFpEF.Methods and resultsIn this retrospective cohort study, patients with HFpEF were divided into groups according to abnormal GLS (>−15.8%) or normal GLS (<−15.8%).The primary outcomes were: a composite of cardiovascular mortality or heart failure hospitalization and deterioration in LVEF to <40%. Among the 311 patients with HFpEF, 128 patients (41%) had normal GLS and 183 patients (59%) had abnormal GLS. After a median follow‐up of 4.6 years, the composite outcome occurred more commonly in patients with abnormal GLS compared to patients with normal GLS (62% vs. 44%; hazard ratio [HR] 1.74, 95% confidence interval [CI] 1.3–2.4, p < 0.001). Patients with abnormal GLS were also more likely to experience a deterioration in LVEF (19% vs. 10%; HR 2.2, 95% CI 1.2–4.3, p = 0.018). When assessed as a continuous variable, each 1% increase in GLS was associated with 10% increased odds for the composite outcome and 13% increased odds for deterioration in LVEF.ConclusionIn patients with HFpEF, abnormal GLS is common and is a strong predictor for clinical events and future deterioration in LVEF.

Global longitudinal strain: Ready for ‘prime time’ in heart failure characterization

“…The study inclusion criteria, and the definition of HFpEF, were similar to those used in the PARAGON-HF trial 4 and therefore it was not surprising that, as mentioned in the supplementary material, the clinical characteristics of their population were rather similar to other HFpEF trials and recent major registries in Europe and North America. 3 The results provide additional data justifying some enthusiasm in using speckle tracking echocardiography to improve the characterization of the HF population. Several previous studies have shown that GLS is really a need and an additive parameter to LVEF.…”

“…Several previous studies have shown that GLS is really a need and an additive parameter to LVEF 5 . In Brann et al ., 3 59% of the HFpEF population had an abnormal GLS (cut‐off of 15.8%) despite a preserved ejection fraction. An important message, out of the risk of event associated with lowest value of GLS, comes from the 1.9‐fold increased risk for LVEF deterioration.…”

“…In this issue, Brann et al 3 . report the results of a retrospective analysis from a cohort of 311 patients with HFpEF with a median follow‐up of 4.6 years.…”

“…The aim was to evaluate the prognostic role of global longitudinal strain (GLS), but also if GLS could predict a deterioration in ejection fraction. The study inclusion criteria, and the definition of HFpEF, were similar to those used in the PARAGON‐HF trial 4 and therefore it was not surprising that, as mentioned in the supplementary material, the clinical characteristics of their population were rather similar to other HFpEF trials and recent major registries in Europe and North America 3 …”

“…GLS >–16% is considered in the HFA‐PEFF score but nowhere yet it is required to report for GLS in the reports about HF patients 12 . Looking at the tremendous contribution of many colleagues in the field of GLS and HF, it is probably relevant to underscore some contributions that reinforced the message of Brann et al 3 …”