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Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial.
- Source :
-
European journal of heart failure [Eur J Heart Fail] 2017 Jul; Vol. 19 (7), pp. 893-900. Date of Electronic Publication: 2017 Feb 14. - Publication Year :
- 2017
-
Abstract
- Background: While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood.<br />Methods and Results: Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n = 187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥ - 16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505 pg/mL (161, 1065) vs. 875 pg/mL (488, 1802), P = 0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7 µg/L (5.1, 8.1) vs. 8.1 µg/L (6.5, 10.5), P = 0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r = 0.29, P < 0.001 and r = 0.19, P = 0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope.<br />Conclusions: Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome.<br /> (© 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.)
- Subjects :
- Aged
Aged, 80 and over
Biomarkers blood
Double-Blind Method
Echocardiography
Exercise Tolerance physiology
Female
Follow-Up Studies
Heart Failure, Systolic blood
Heart Failure, Systolic diagnosis
Heart Ventricles diagnostic imaging
Humans
Male
Middle Aged
Natriuretic Peptide, Brain blood
Oxygen Consumption
Peptide Fragments blood
Procollagen blood
Quality of Life
Retrospective Studies
Time Factors
Heart Failure, Systolic physiopathology
Heart Ventricles physiopathology
Myocardial Contraction physiology
Stroke Volume physiology
Ventricular Function, Left physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0844
- Volume :
- 19
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- European journal of heart failure
- Publication Type :
- Academic Journal
- Accession number :
- 28194841
- Full Text :
- https://doi.org/10.1002/ejhf.754