What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Heart failure with preserved ejection fraction (HFpEF) (n=60). Intervention: Global longitudinal strain (GLS) assessment vs. Healthy controls and HFrEF patients. Primary outcome: Global longitudinal strain (GLS) (p=<0.001).

January 21, 2019Open Access

Role of global longitudinal strain in assessment of left ventricular systolic function in patients with heart failure with preserved ejection fraction

Q: What are the key findings of this study?

Global longitudinal strain detected significant left ventricular systolic impairment in patients with heart failure with preserved ejection fraction (-15.03%) compared to controls (-19.74%).

Q: What does this research mean for the field?

Global longitudinal strain detects significant left ventricular systolic impairment in patients with heart failure with preserved ejection fraction (-15.03%) compared to controls (-19.74%), despite normal left ventricular ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

HBHasanain Ali Hameed BshiebishUniversity of Alkafeel AAAli Hussein Ahmed AlmusawiUniversity of Alkafeel SKSafaa Ali KhudeirUniversity of Kufa

Key Result

Global longitudinal strain detected significant left ventricular systolic impairment in patients with heart failure with preserved ejection fraction (-15.03%) compared to controls (-19.74%).

Study Design

Type

Cross-Sectional (n=60)

Multicenter

Structured PICO

Does global longitudinal strain (GLS) detect left ventricular systolic impairment in patients with heart failure with preserved ejection fraction (HFpEF)?

Population

60 patients evaluated at a single center in Iraq, including 20 with HFrEF (LVEF < 40%), 20 with HFpEF (LVEF > 50%, LAVI ≥ 34 mL/m2 or LVMI ≥ 115/95 g/m2, E/e' ≥ 13), and 20 controls with risk factors but no HF symptoms (LVEF > 50%, E/e' < 8).

Intervention

Measurement of left ventricular Global Longitudinal Strain (GLS) using two-dimensional speckle tracking echocardiography (Automated Functional Images software).

Comparator

Comparison of echocardiographic parameters across the three groups (HFpEF, HFrEF, and controls).

Outcome

Left ventricular global longitudinal strain (GLS) value.surrogate

Global longitudinal strain (GLS) can detect underlying left ventricular systolic impairment in patients with HFpEF despite a normal left ventricular ejection fraction.

Main Result

Absolute Event Rate: -15.03% vs -19.74%

p-value: p=<0.001

Limitations

Measurement of BNP or pro-BNP were not performed for the study participants.
Diagnosis was based on clinical history, physical examination, electrocardiogram, and echocardiography without natriuretic peptide levels.

Abstract

To detect systolic dysfunction in heart failure with preserved ejection fraction (HFpEF) patients by using global longitudinal strain (GLS). This study included 46 heart failure patients: 24 with heart failure with reduced ejection fraction (HFrEF) and 22 with heart failure with preserved ejection fraction (HFpEF), and 20 patients with similar risk factor but no symptoms or signs of heart failure, matched for age and sex, as controls. All patients were screened by echocardiography. The ejection fraction of left ventricle was measured using Simpson’s method and the GLS of the left ventricle was measured by using two-dimensional speckle tracking. Left ventricular ejection fraction (LVEF) was 61.90 ± 2.94% in the controls, 60.45 ± 7.4% in the HFpEF group (p = 0.421), and 32.75 ± 8.45% in the HFrEF group (p = 0.001). The value of left ventricle (LV) GLS (controls = −19.74 ± 1.12%, HFpEF = −15.03 ± 2.03%, HFrEF = −10.72 ± 1.99%, p = 0.0001) was significantly impaired in the HFpEF group despite normal LVEF. There is significant left ventricular systolic impairment detected by GLS despite preserved LVEF.

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