Left Ventricular Mechanical Dispersion and Its Value in Combination With Global Longitudinal Strain to Predict Reverse Remodeling in Patients With Heart Failure With Reduced Ejection Fraction

Figures

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  Figure 1. Flow chart of the study population. HFrEF indicates heart failure with reduced ejection fraction; and TTE, transthoracic echocardiography.

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  Figure 2. Longitudinal strain and mechanical dispersion in a patient with LVRR (A) and another without LVRR (B). Two representatives of bull's‐eye display of GLS and longitudinal strain curves in the apical 4‐chamber view are shown. A, Strain output from a patient experiencing LVRR with LVEF 19%, LV‐GLS −5.5%, and LV‐MD 65 msec. B, Strain output from a patient experiencing no LVRR with LVEF 27%, LV‐GLS −7.9%, and LV‐MD 106 msec. Note the patient with LVRR had lower LV‐MD even with worse LVEF and GLS. Yellow vertical lines indicate onset of Q/R on the ECG. White horizontal arrows indicate contract duration (time to peak negative strain) in each LV segment. GLS indicates global longitudinal strain; LV, left ventricular; LVEF, left ventricular ejection fraction; LVRR, left ventricular reverse remodeling; and MD, mechanical dispersion.

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  Figure 3. ROC curves of baseline LV‐MD and LV‐GLS to predict LVRR. ROC curves showing the AUC of baseline LV‐MD (red curve) and LV‐GLS (green curve) in the prediction of LVRR. The DeLong test was used to compare the AUCs. AUC indicates area under the curve; GLS, global longitudinal strain; LV, left ventricular; LVRR, left ventricular reverse remodeling; MD, mechanical dispersion; and ROC, receiver operating characteristic.

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  Figure 4. Prevalence of LVRR stratified by LV‐GLS and LV‐MD. Group A: LV‐MD >76 msec and LV‐GLS>−5.5%; Group B: LV‐MD >76 msec or LV‐GLS>−5.5%; Group C: LV‐MD ≤76 msec and LV‐GLS ≤−5.5%. GLS indicates global longitudinal strain; LV, left ventricular; LVRR, left ventricular reverse remodeling; and MD, mechanical dispersion.

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  Figure 5. Relationship between baseline LV‐MD and changes in LVEF, LVEDV, and LVESV at follow‐up. The Spearman rank correlation test was used to determine the correlation between baseline LV‐MD and changes of LVEF (A), LVEDV (B), and LVESV (C) at follow‐up. LVEF change was defined as the absolute difference between baseline and follow‐up LVEF. LVEDV and LVESV changes were calculated as absolute differences divided by absolute values at baseline. LV indicates left ventricular; LVEDV, left ventricular end‐diastolic volume; LVEF, left ventricular ejection fraction; LVESV, left ventricular end‐systolic volume; LVRR, left ventricular reverse remodeling; and MD, mechanical dispersion.

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  Figure 6. Incremental value of MD over clinical parameters and GLS as a correlate of LVRR. *P value according to comparison between chi‐square values of different models performed by likelihood ratio test. ARNI indicates angiotensin receptor‐neprilysin inhibitors; GLS, global longitudinal strain; HF, heart failure; LV, left ventricular; LVRR, left ventricular reverse remodeling; MD, mechanical dispersion; OR, odds ratio; and SBP, systolic blood pressure.