Left ventricular strain outperformed conventional ejection fraction in predicting overall survival (Harrell's C-index 0.71 vs 0.56, P<0.001) and better discriminated the therapeutic efficacy of ARNi.
Cohort (n=1,075)
Does left ventricular strain provide better prognostic insight and discriminate the therapeutic efficacy of ARNi better than LVEF in patients with HFmrEF?
LV strain provides superior prognostic value and better identifies patients who will benefit from ARNi therapy compared to conventional LVEF in HFmrEF.
Effect estimate: Harrell's C-index 0.71 vs 0.56
p-value: p=<0.001
Left ventricular (LV) systolic strain is presumably a more sensitive myocardial indicator than LV ejection fraction (LVEF). Data regarding the use of LV strain in clinical risk stratification and in identifying angiotensin receptor-neprilysin inhibitor (ARNi) responders remain scarce in heart failure with mildly reduced ejection fraction (HFmrEF). The authors aimed to examine whether assessing LV strain may provide prognostic insight beyond LVEF and help discriminate the therapeutic efficacy of ARNi in HFmrEF patients. LVEF and LV strain were quantified among 1,075 first-time hospitalized HFmrEF patients (mean age: 68.1 ± 15.1 years, 40% female). The MAGGIC (Meta-analysis Global Group in Chronic Heart Failure) risk score and its components were calculated. A Cox proportional hazard model was constructed for time-to-event analysis. Restrictive cubic spline curves were used to model the therapeutic effects of ARNi against renin-angiotensin system inhibitor according to baseline LVEF or LV strain. LV strain showed a statistically significant inverse association with MAGGIC cardiac risk (coefficient: −0.14, P < 0.001). LV strain was independently associated with clinical outcomes after accounting for LVEF. MAGGIC-LV strain strata outperformed MAGGIC-LVEF strata in overall survival (Harrell’s C-index: 0.71 and 0.56, P for difference <0.001; category-free net reclassification index: 0.44, P < 0.001). Lower LV strain but not LVEF consistently showed the beneficial therapeutic effects of ARNi against renin-angiotensin system inhibitor by Cox models and restrictive cubic spline (all Pinteraction <0.05). Among HFmrEF patients, LV strain may serve as an attractive systolic marker and provide a better prognostic and therapeutic discriminative measure for ARNi treatment than conventional LVEF.
Chung et al. (Wed,) conducted a cohort in Heart failure with mildly reduced ejection fraction (HFmrEF) (n=1,075). Left ventricular strain assessment vs. Left ventricular ejection fraction assessment was evaluated on Overall survival (Harrell's C-index 0.71 vs 0.56, p=<0.001). Left ventricular strain outperformed conventional ejection fraction in predicting overall survival (Harrell's C-index 0.71 vs 0.56, P<0.001) and better discriminated the therapeutic efficacy of ARNi.