Myocardial Strain for Heart Failure with Preserved Ejection Fraction but Without Diastolic Dysfunction

Figures

• 

  Figure 1. Study population. BNP, B‐type natriuretic peptide; HFpEF, heart failure with preserved ejection fraction; LVEF, left ventricular ejection fraction; NT‐pro‐BNP, N‐terminal pro‐B‐type natriuretic peptide.

• 

  Figure 2. Kaplan–Meier estimates of 5 year all‐cause mortality and hospitalization for heart failure in patients with preserved EF. Among patients with preserved EF, HFpEF patients with significant diastolic dysfunction had higher all‐cause mortality (A) and higher the composite of all‐cause mortality or hospitalization for heart failure (B) than the suspicious HFpEF patients without significant diastolic dysfunction. ACM, all‐cause mortality; GLS, global longitudinal strain; HFpEF, heart failure with preserved ejection fraction; HHF, hospitalization for heart failure; HR, hazard ratio; CI, confidence interval.

• 

  Figure 3. Kaplan–Meier estimates of 5 year all‐cause mortality and hospitalization for heart failure in patients with suspicious HFpEF without diastolic dysfunction. Among suspicious HFpEF without diastolic dysfunction, those with impaired GLS had higher all‐cause mortality (A) and higher the composite of all‐cause mortality or hospitalization for heart failure (B). ACM, all‐cause mortality; GLS, global longitudinal strain; HFpEF, heart failure with preserved ejection fraction; HHF, hospitalization for heart failure; HR, hazard ratio; CI, confidence interval.

• 

  Figure 4. Kaplan–Meier estimates of 5 year all‐cause mortality and hospitalization for heart failure in patients with HFpEF and suspicious HFPEF with impaired GLS. The mean GLS was 14.7 ± 4.7% for HFpEF and 12.5 ± 2.7 for suspicious HFpEF with impaired GLS. Suspicious HFpEF patients with impaired GLS had lower all‐cause mortality (A) and lower the composite of all‐cause mortality or hospitalization for heart failure (B). ACM, all‐cause mortality; GLS, global longitudinal strain; HFpEF, heart failure with preserved ejection fraction; HHF, hospitalization for heart failure; HR, hazard ratio; CI, confidence interval.

• 

  Figure 5. When stratifying these patients according to global longitudinal strain (GLS) and comparing them to age and sex‐matched population, suspicious HFpEF patients with impaired GLS had a worse prognosis, whereas those with normal GLS had similar outcomes as the controls (A). Patients with LVEF ≥50% and elevated levels of NPs, without significant diastolic dysfunction would have been classified as not having HF per contemporary definition of HFpEF. Because HF is a disease with worse prognosis, only those with impaired GLS are true, invisible HF patients. Therefore, myocardial strain may be used to identify invisible HF patients (B). GLS, global longitudinal strain; LVEF, left ventricular ejection fraction; HR, hazard ratio; CI, confidence interval.