“Role of Strain Rate Imaging of Left Ventricle to Assess Underlying Systolic Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction (Hfpef)”

Introduction: HFpEFis increasing 1% per year when compared to HFrEF with an ageing population and rising risk-factors like hypertension,obesity&diabetes.Endothelial-dysfunction, proteininteractions,signaling-pathways&myocardial-bioenergetics are the suggested pathophysiological causes for HFpEF.2D-STEhas been utilised to identify HFpEF by focusing on the LV-GLS. To assess the predictive valueAim: of strain-rate imaging in detecting systolic-dysfunction among patients with HFpEF&Severity of diastolic-dysfunction in relation to the systolic- dysfunction by echocardiography. Among 50 patients with HFpEF,majority of patients were in age group 56-65 years.In our observationResults: 46% were hypertensive,32% were diabetic,2% wereobese,2% had OSA,18% had dyslipidemia,12% were hypothyroid,44% of patients were on betablocker therapy,NYHA class II,III,lV breathlessness was in 36%,42%,22% respectively at the time of presentation.We observed E/e' > 15 was noted in 22% patients and 78% had normal LV-lling pressures,40% had mitral E/A ratio 0.8-1.5,48% had mitral E/A ratio <0.8,2% had mitral E/A ratio 1.5 - 2,10% had mitral E/A ratio >2,LA-volume > 40ml in 38% patients and <40 ml in 62% patients.96% had LVEDD of 4.2-5.8 cm& 2% had LV EDD of 5.9-6.3 ,TR velocity was found to be <2.8 m/sec in 98% & 2% had >2.8 m/sec.Average LV-GLS was found to be reduced(<- 16%) in 64%,borderline reduced(-16% to -18%) in 24%, >-18% in 12% patients.In HFpEF,both GLS and GCS were related to LVEF(LS,R = −0.46; p<0.0001;CS,R = −0.51;p<0.0001) but not to standard echocardiographic measures of diastolic-function(E' or E/E').Lower GLS was modestly associated with higher NT-proBNP,includingLVEF,measures of diastolic-function and LV-lling pressure. HFpEF is aConclusions: major cause of morbidity and mortality,utility of GLS and GCS is cost-effective way to assess underlying systolic-dysfunction in patients with HFpEF,guides clinician for prognostication and management.