Authors: Pierpaolo Pellicori Anna KallvikbackaBennett Olga Khaleva Valentina Carubelli Pierluigi Costanzo Teresa Castiello Kenneth Wong Jufen Zhang John G F Cleland Andrew L Clark
Publish Date: 2013/10/23
Volume: 30, Issue: 1, Pages: 69-79
Abstract
Many patients have clinical structural or biomarker evidence of heart failure HF but a normal left ventricular ejection fraction LVEF HeFNEF Measurement of global longitudinal strain GLS may add diagnostic and prognostic information Patients with symptoms suggesting heart failure and LVEF ≥50 were studied 76 had no substantial cardiac dysfunction left atrial diameter LAD 40 mm and aminoterminal probrain natriuretic peptide NTproBNP 400 ng/l 99 had “possible HeFNEF” LAD ≥40 mm or NTproBNP ≥400 ng/l and 138 had “definite HeFNEF” LAD ≥40 mm and NTproBNP ≥400 ng/L Mean LVEF was 58 in each subgroup Patients with definite HeFNEF were older more likely to have atrial fibrillation had more symptoms and signs of fluid retention were more likely to have right ventricular dysfunction and had higher pulmonary pressures than other groups Mean GLS SD was less negative in patients with definite HeFNEF −136 30 vs possible HeFNEF −152 31 vs no substantial cardiac dysfunction −159 24 p 0001 GLS was −191 21 in 20 controls During a median follow up of 647 days cardiovascular death or an unplanned hospitalisation for heart failure occurred in 62 patients In univariable analysis GLS but not LVEF predicted events However in a multivariable analysis only urea NTproBNP left atrial volume inferior vena cava diameter and atrial fibrillation independently predicted adverse outcome GLS is abnormal in patients who have other evidence of HeFNEF is associated with a worse prognosis in this population but is not a powerful independent predictor of outcome
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