Predictive value of left ventricular myocardial constructive work in patients with heart failure with preserved ejection fraction and preclinical diastolic dysfunction.

Abstract

Background: We aimed to find predictors of ejection fraction (EF) deterioration in heart failure with preserved EF (HFpEF) patients to prevent their further deterioration.

Methods: We studied 215 patients (mean age, 73 ± 8 years; 63% women) with HFpEF and with records of Charlson Comorbidity Index, glomerular filtration rate. Myocardial work, global longitudinal, radial, circumferential, and area strain. The global work index, global constructive work (GCW), wasted work, global work efficiency was obtained by echocardiography. Patients were followed up for 3 years.

Results: Five patients developed myocardial infarction and were excluded from the study. Baseline EF was higher in female patients (61.2% ± 3.1% vs. 56.4% ± 2.7%, P < 0.002), in patients aged > 70 years (62.4% ± 2.1% vs. 57.1% ± 2.3%, P < 0.005), and in patients with end-diastolic volume index < 60 mL/m² (56.1% ± 3.2% vs. 63.4% ± 2.3%, P < 0.001). EF decline compared to baseline was -7.3% ± 1.6% (P < 0.01). EF decline was significantly more in patients aged > 70 years, in patients with coronary artery disease and did not relate to sex, left ventricle size, cardiac index, and glomerular filtration rate. During follow-up 58 patients (27%) had EF < 50%, worsening in area strain (-27.9% ± 8.5% vs. -24.7% ± 5.3%, P < 0.003), global longitudinal strain (-19.7% ± 2.4% vs. -17.1% ± 1.6%, P < 0.005), and GCW (2,378% ± 117% vs. 2,102% ± 10%, P < 0.002). Patients with EF < 50% at the end of the study had less area strain and GCW baseline values compared with patients with EF > 50% (22.4% ± 7.2% vs. -27.6% ± 8.1%, P < 0.002; 2,081 ± 92 vs. 2,489 ± 127, P < 0.001). GCW was the predictor of EF deterioration (area under curve, 0.8853).

Conclusions: GCW predicts EF decline in HFpEF patients which may help identify this subset of patients and prevent their further deterioration earlier.