Comparison of Left Ventricular Longitudinal Systolic Function Parameters in the Prediction of Adverse Outcome in Heart Failure with Preserved Ejection Fraction
Key result
Global longitudinal strain after exercise predicted heart failure hospitalization and cardiovascular death in HFpEF patients (HR 0.84; 95% CI 0.77-0.91; P<0.001).
Why the study?
Multiple diagnostic parameters assess left ventricular longitudinal systolic function, but studies comparing their predictive value in heart failure with preserved ejection fraction had not been conducted.
Which echocardiographic parameters of left ventricular longitudinal systolic function at rest and exercise best predict adverse outcomes in patients with HFpEF?
Population
201 patients with HFpEF
Comparison
Echocardiographic LV longitudinal systolic function parameters at rest vs immediately after exercise
Design
Cohort study
Follow-up
48 (24–60) months
Authors
Discussion
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Member takes
Implication
Exercise GLS may enhance HFpEF risk stratification; extends resting parameters with stronger outcome prediction.
Key Points
- The aim is to evaluate and compare the prognostic value of various left ventricular longitudinal systolic function parameters in heart failure with preserved ejection fraction.
- Collected clinical and biochemical variables from 201 patients with HFpEF at baseline.
- Echocardiography measurements were taken at rest and after exercise, focusing on longitudinal function parameters.
- Follow-up for heart failure hospitalization and cardiovascular death was conducted over 48 months.
- Among participants, 36.8% experienced heart failure hospitalization or cardiovascular death.
- Global longitudinal strain (GLS) at rest showed a significant association with outcomes (HR 0.91, 95% CI 0.84-0.98, P=0.016).
- GLS after exercise demonstrated the strongest predictive value (HR 0.84, 95% CI 0.77-0.91, P<0.001), with exercise GLSR also showing significant predictive ability (HR 0.13, 95% CI 0.04-0.48, P=0.002).
Study Design
Type
Cohort (n=201)
Structured PICO
Which echocardiographic parameters of left ventricular longitudinal systolic function at rest and exercise best predict adverse outcomes in patients with HFpEF?
P
Population
201 patients with heart failure with preserved ejection fraction followed for a median of 48 months.
E
Exposure
Echocardiographic assessment of left ventricular longitudinal systolic function at rest and immediately after exercise (including mitral annular plane systolic excursion, systolic tissue velocity [s′], global longitudinal strain [GLS], and global longitudinal strain rate [GLSR])
O
Outcome
Composite of heart failure hospitalization and cardiovascular deathcomposite
Main Result
Hazard Ratio: 0.84 (95% CI 0.77–0.91)
p-value: p=<0.001
Left ventricular deformation indices, particularly global longitudinal strain assessed during exercise, provide independent and incremental prognostic value over clinical data and BNP in patients with HFpEF.
Cite This Study
Goździk et al. (2021) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=201). Left ventricular longitudinal systolic function parameters (GLS and GLSR) was evaluated on Heart failure hospitalization and cardiovascular death (HR 0.84, 95% CI 0.77-0.91, p=<0.001). Global longitudinal strain after exercise predicted heart failure hospitalization and cardiovascular death in HFpEF patients (HR 0.84; 95% CI 0.77-0.91; P<0.001).