Left ventricular longitudinal systolic function analysed by 2D speckle-tracking echocardiography in heart failure with preserved ejection fraction: a meta-analysis

Morris, Daniel A.; Ma, Xinxin; Belyavskiy, Evgeny; Kumar, Radhakrishnan Aravind; Kropf, Martin; Kraft, Robin; Frydas, Athanasios; Osmanoglou, Engin; Marquez, Esteban; Donal, Erwan; Edelmann, Frank; Tschöpe, Carsten; Pieske, Burkert; Pieske‐Kraigher, Elisabeth

doi:10.1136/openhrt-2017-000630

Cited by 88 publications

(77 citation statements)

References 37 publications

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“…13 Previous reports demonstrated that LVGLS related to exercise capacity through the poor contractile reserve during exercise. [14][15][16] Actually, in the present study, LVGLS in the G < 50 was worst compared to the other two groups. LVGLS was significantly impaired in the G < 50 than in other two groups.…”

Section: The Ability Of E/lvgls To Detect Impaired Exercise Capacitycontrasting

confidence: 53%

“…This finding was concordant with previous reports. [14][15][16] The use of β blocker and diuretics was most frequent, and NT pro-BNP was highest in the G < 50 among groups. Therefore, we tested the influence of these medical therapies and NT-proBNP on exercise capacity by multivariate analysis.…”

Section: The Ability Of E/lvgls To Detect Impaired Exercise Capacitymentioning

confidence: 99%

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Early mitral inflow velocity to left ventricular global strain ratio predicts limited exercise capacity

et al. 2019

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Background Estimation of left ventricular filling pressure (LVFP) is the essential part of the echocardiographic workup for exercise intolerance. The ratio of the mitral early filling velocity to the left ventricular global longitudinal strain (E/LVGLS) has emerged as a novel index of LVFP. This study aimed to investigate the relationship between E/LVGLS and exercise capacity. Methods and results We retrospectively reviewed 90 patients with exertional dyspnea who underwent echocardiography and cardiopulmonary exercise test. Patients were classified into three groups according to their percent‐predicted maximal oxygen consumption (ppVo2) (G ≧ 75, ppVo2 > 75%, n = 20; G 50‐75, ppVo2 75‐50%, n = 57; G < 50, ppVo2 < 50%, n = 13). Measurements were (a) the relationship between ppVo2 and E/LVGLS and (b) the efficiency of integrated diastolic assessment using E/LVGLS, left ventricular volume, mitral annular early diastolic velocity (E′), and tricuspid regurgitation to identify the patient with impaired exercise capacity. Univariate linear regression analysis demonstrated that E/LVGLS had significant correlation with ppVo2 (ρ = 0.52, P < 0.001). The area under the ROC of E/LVGLS for ppVo2 < 50% was 0.86 (95%CI 0.75‐0.97). The DeLong test showed that E/LVGLS was efficient to detect ppVo2 < 50% than E/E′ (P = 0.007). When used in the integrated assessment of LVFP as the alternative for E/E′, E/LVGLS improved risk classification for impaired exercise capacity. Conclusion E/LVGLS may be a more efficient index than E/E′ to identify exercise impairment as a single index and as a part of the integrated diastolic assessment.

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Section: The Ability Of E/lvgls To Detect Impaired Exercise Capacitycontrasting

confidence: 53%

Section: The Ability Of E/lvgls To Detect Impaired Exercise Capacitymentioning

confidence: 99%

Early mitral inflow velocity to left ventricular global strain ratio predicts limited exercise capacity

et al. 2019

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“…In our study, we categorized the included patients into three subgroups according to LAVI and NT‐proBNP level and focused on the potential predictive value of LV deformation parameters and RDW in HFpEF. A meta‐analysis analyzing 2284 patients with HFpEF and 2302 controls confirmed that the longitudinal systolic function of the LV is dramatically impaired in a large proportion of patients with HFpEF . In our study, we found that in definite HFpEF patients who had the largest LAVI and highest NT‐proBNP levels, the absolute values of GLS, GRS, GCS, and GAS were all significantly lower than those in the other two subgroups, and the RDW value was significantly higher than that in the rest subgroups.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction

et al. 2019

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Objectives The diagnostic difficulty of heart failure with preserved ejection fraction (HFpEF) is differentiating it in patients with similar symptoms and signs. This study aimed to assess the potential predictive value of left ventricular global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), and global area strain (GAS) measured by four‐dimensional speckle tracking echocardiography (4DSTE) combined with red cell distribution width (RDW) in patients with HFpEF. Methods One hundred and sixty‐nine patients with symptoms or signs indicative of chronic heart failure and a left ventricular ejection fraction (LVEF) ≥ 50% and fifty controls with normal LVEF were recruited in this study. Standard echocardiography and 4DSTE examinations were performed. Laboratory examinations including RDW were performed on the same day as the echocardiographic study. Results GLS, GCS, GRS, and GAS in the patient cohort were significantly lower, and RDW was significantly higher than those in the control cohort (P < 0.01), and the strain parameters in definite HFpEF patients were also dramatically lower than the rest patients (P < 0.01). The associations of age, gender, NYHA classification, hypertension history, left ventricular end‐diastolic volume index, interventricular septal thickness, and diastolic dysfunction with HFpEF were significantly improved by adding 4DSTE parameters (P < 0.01) and further improved by adding RDW (P < 0.01). Conclusions In suspected HFpEF patients, who have symptoms or signs of heart failure, even without other conventional evidence of this diagnosis, GLS, GRS, and GCS have potential independent predictive value, while RDW has independent incremental predictive value for HFpEF.

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“…214 Reduced LV longitudinal systolic strain and LV early diastolic strain rate have both been identified in HFpEF. 19,215,216 Impaired GLS predicts HF hospitalization, cardiovascular death, or cardiac arrest. 216,217 It correlates with invasive measurements of LV stiffness and with NP levels.…”

Section: Minor Criterion∶ Gls < 16%mentioning

confidence: 99%

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Pieske

Tschöpe

Boer

et al. 2020

European J of Heart Fail

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415

643

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Making a firm diagnosis of chronic heart failure with preserved ejection fraction (HFpEF) remains a challenge. We recommend a new stepwise diagnostic process, the ‘HFA–PEFF diagnostic algorithm’. Step 1 (P=Pre‐test assessment) is typically performed in the ambulatory setting and includes assessment for heart failure symptoms and signs, typical clinical demographics (obesity, hypertension, diabetes mellitus, elderly, atrial fibrillation), and diagnostic laboratory tests, electrocardiogram, and echocardiography. In the absence of overt non‐cardiac causes of breathlessness, HFpEF can be suspected if there is a normal left ventricular (LV) ejection fraction, no significant heart valve disease or cardiac ischaemia, and at least one typical risk factor. Elevated natriuretic peptides support, but normal levels do not exclude a diagnosis of HFpEF. The second step (E: Echocardiography and Natriuretic Peptide Score) requires comprehensive echocardiography and is typically performed by a cardiologist. Measures include mitral annular early diastolic velocity (e′), LV filling pressure estimated using E/e′, left atrial volume index, LV mass index, LV relative wall thickness, tricuspid regurgitation velocity, LV global longitudinal systolic strain, and serum natriuretic peptide levels. Major (2 points) and Minor (1 point) criteria were defined from these measures. A score ≥5 points implies definite HFpEF; ≤1 point makes HFpEF unlikely. An intermediate score (2–4 points) implies diagnostic uncertainty, in which case Step 3 (F1: Functional testing) is recommended with echocardiographic or invasive haemodynamic exercise stress tests. Step 4 (F2: Final aetiology) is recommended to establish a possible specific cause of HFpEF or alternative explanations. Further research is needed for a better classification of HFpEF.

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Left ventricular longitudinal systolic function analysed by 2D speckle-tracking echocardiography in heart failure with preserved ejection fraction: a meta-analysis

Cited by 88 publications

References 37 publications

Early mitral inflow velocity to left ventricular global strain ratio predicts limited exercise capacity

Early mitral inflow velocity to left ventricular global strain ratio predicts limited exercise capacity

Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction

How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

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