Do advanced echocardiographic indices (GLS, LA strain, E/e', TAPSE/PASP) predict mortality and heart failure readmissions over a 12-month period in elderly patients with acute decompensated HFpEF?
Advanced echocardiographic markers (GLS, LA reservoir strain, E/e', and TAPSE/PASP) are strong predictors of 1-year readmission and mortality in elderly HFpEF patients, offering superior risk stratification compared to conventional parameters.
Introduction Heart failure with preserved ejection fraction (HFpEF) is a major cause of hospitalization in the elderly, associated with high morbidity and recurrent admissions despite preserved left ventricular ejection fraction (LVEF ≥50%). Traditional echocardiographic markers may not adequately reflect the underlying myocardial dysfunction. Advanced indices such as global longitudinal strain (GLS), left atrial (LA) reservoir strain, early mitral inflow to early diastolic mitral annular velocity (e/e') ratio, and the tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio offer better prognostic insight. This study aimed to evaluate the predictive value of these echocardiographic parameters in determining mortality and heart failure readmissions over a 12-month period in elderly HFpEF patients. Study A prospective observational study was conducted at Stanley Medical College, Chennai, from February 2023 to December 2024. A total of 220 patients aged ≥60 years, admitted with acute decompensated HFpEF, were included. Standard and advanced echocardiography were performed within 72 hours of stabilization. Parameters measured included GLS, LA reservoir strain, E/e' ratio, LA volume index, TAPSE, and PASP. Patients were followed up at 30 days, 90 days, six months, and one year for readmission and mortality outcomes. Statistical significance was set at p15) in 157 (71.4%), and abnormal TAPSE/PASP (-16 group. Patients with LA strain 23%. Elevated E/e' >15 predicted 103 readmissions (65.6%) and 31 deaths (19.7%) vs. 26 (41.3%) and 10 (15.9%) in those having E/e' ≤15. TAPSE/PASP <0.42 was linked to 66 readmissions (81.5%) and 19 deaths (23.5%) compared to 63 readmissions (45.3%) and 22 deaths (15.8%) in those with TAPSE/PASP ≥0.42. All associations were statistically significant. Conclusion Advanced echocardiographic markers - GLS, LA reservoir strain, E/e', and TAPSE/PASP - were strong predictors of one-year readmission and mortality in elderly HFpEF patients. These indices offer superior risk stratification compared to conventional parameters and may guide post-discharge planning. Incorporating them into routine inpatient evaluation could improve outcomes through early identification of high-risk individuals and targeted follow-up strategies.
Selvan et al. (Sun,) studied this question.