Key result
Impaired dual-chamber strains linked to ~66% higher 5-year mortality risk vs preserved strains in HFpEF.
Why the study?
HFpEF is a heterogeneous syndrome, and it was unknown whether phenotyping based on dual-chamber strain analysis provides incremental prognostic value.
Does phenotypic grouping using left ventricular and left atrial strains predict 5-year all-cause mortality in patients with HFpEF?
Cohort (n=1,184)
Yes
Does phenotypic grouping using left ventricular and left atrial strains predict 5-year all-cause mortality in patients with HFpEF?
Combined assessment of left ventricular and left atrial strain identifies distinct HFpEF phenotypes and independently predicts 5-year all-cause mortality.
Supports dual-chamber strain phenotyping for HFpEF prognostication; leaves open whether it alters management or outcomes.
AIMS: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with poor clinical outcomes similar to HF with reduced ejection fraction. We investigated whether phenotyping based on dual-chamber strain analysis (left ventricular global longitudinal strain [LVGLS] and left atrial reservoir strain [LARS]) provides incremental prognostic value in patients with HFpEF. METHODS AND RESULTS: We analyzed dual-chamber strains from all HFpEF patients in the multicenter STRATS-AHF registry. We categorized all patients into four groups according to cut-off values (LVGLS ≤-16%; LARS ≥18%). The primary outcome was 5-year all-cause mortality. We analyzed a total of 1,184 HFpEF patients (mean age: 73.4 years, 60.4% female) and categorized them into four groups: Group 1 (preserved dual-chamber strains, n = 340), Group 2 (impaired LVGLS/preserved LARS, n = 239), Group 3 (preserved LVGLS/impaired LARS, n = 186), and Group 4 (impaired dual-chamber strains, n = 419). Compared with Group 1, Group 4 exhibited the highest prevalence of atrial fibrillation (AF, 62.8%), the highest E/e' ratio, and the most impaired right ventricular global longitudinal strain. In univariate analysis, mortality risk increased progressively from Group 2 to Group 4 (Group 2: HR = 1.341, P = 0.016; Group 3: 1.578, P < 0.001; Group 4: HR = 1.822, P < 0.001). In multivariate models, Group 2 (adjusted HR = 1.664, P = 0.011) and Group 4 (adjusted HR = 1.660, P = 0.026) remained independent predictors of death compared to Group 1. Group 3 demonstrated insignificant risk after adjusting for other variables, including age and AF (adjusted HR = 1.509, P = 0.171). CONCLUSIONS: Combined LV and LA strain assessment identified distinct HFpEF phenotypes and provided valuable prognostic information in HFpEF patients.
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Lee et al. (2026) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=1,184). Impaired dual-chamber strains (LVGLS and LARS) vs. Preserved dual-chamber strains was evaluated on 5-year all-cause mortality (adjusted HR 1.660, p=0.026). Impaired dual-chamber strains were independently associated with an increased risk of 5-year all-cause mortality compared to preserved strains in patients with HFpEF (adjusted HR 1.660, P=0.026).
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