Septal mitral annular systolic excursion but not global longitudinal strain predicts outcome in non-ischemic heart failure patients with reduced ejection fraction and mild diastolic dysfunction

Abstract Background Speckle tracking derived global longitudinal strain (GLS) could provide incremental prognostic information over left ventricular ejection fraction (LVEF) in the general population and a variety of cardiovascular diseases. Mitral annular systolic excursion (MAPSE) is a classical echocardiographic index with prognostic implication in patients with various cardiovascular diseases. Present study aimed to test the hypothesis that reduced GLS is superior to MAPSE on predicting all-cause mortality in non-ischemic heart failure patients with reduced ejection fraction. Methods A total of 952 patients with non-ischemic heart failure and reduced LVEF, who referred to our department between 2009 and 2017, were included in this study (mean age: 66±15 years, 68.8% male). All patients underwent a routine transthoracic echocardiography examination at baseline visit. Standard echocardiographic measurements were conducted according to recent guidelines. GLS was derived from the segmental averaging (18-segment) of the three apical views. M-mode MAPSE of septal and lateral walls were obtained from standard apical 4-chamber view. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoint was defined as all-cause mortality or heart transplantation (HTx). Results Over a median follow-up period of 27 (14–40) months, 259 (27.2%) patients died and 9 (0.9%) underwent HTx. MAPSE_septal was significantly lower in non-survivors than in survivors (6 (5–8) vs. 7 (5–8) mm, P=0.009), while LVEF (36% vs. 36%, P=0.927) and GLS (−9.6% vs. −9.8%, P=0.473) were similar between non-survivors and survivors. All-cause mortality was significant higher in patients with MAPSE_septal<5mm than those with MAPSE_septal ≥5mm (34.9% vs. 26.7%, P=0.032). All-cause death increased in proportion with increased severity of diastolic dysfunction (DD, 20.4%, 29.6% and 34.0% in patients with mild, moderate and severe DD, P=0.002). Multivariable Cox regression analysis showed that reduced MAPSE_septal (<5mm, HR=1.451, 95% CI=1.079–1.951, P=0.014) was independently associated with increased all-cause mortality adjusted for clinical confounders including age, sex, NYHA class, atrial fibrillation, diabetes, hyperuricemia, chronic respiratory diseases, sleep disturbance, while MAPSE_lateral, LVEF, and GLS were not outcome determinants in this patient cohort. Subgroup analysis showed that mild DD (n=269), reduced MAPSE_septal were significantly associated with increased all-cause mortality (adjusted HR=3.734, 95% CI=1.850–7.536, P<0.001), while MAPSE_septal was not a risk factor of all-cause mortality in the subgroup of moderate to severe DD (n=667, HR=1.314, P=0.108). Conclusions Septal MAPSE, but not LVEF or GLS, serves as an independent determinant of all-cause mortality in non-ischemic heart failure patients with reduced LVEF and mild diastolic dysfunction. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research

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Prognostic value of global longitudinal strain versus mitral annular plane systolic excursion in patients with ischemic heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1011 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Liu ◽

C Wagner ◽

K Hu ◽

B Lengenfelder ◽

G Ertl ◽

...

Keyword(s):

Heart Failure ◽

Longitudinal Strain ◽

Nyha Class ◽

Global Longitudinal Strain ◽

Ischemic Heart ◽

Ischemic Heart Failure ◽

Class Iii ◽

Heart Failure Patients ◽

All Cause Mortality

Abstract Background Mitral annular plane systolic excursion (MAPSE) derived from M-mode echocardiography is a classical risk factor of clinical outcome in heart failure patients. Two-dimensional-echocardiography (2DE) derived global longitudinal strain (GLS) is also related to outcome in patients with heart failure. This study aimed to compare the prognostic performance between GLS and MAPSE in ischemic heart failure patients with reduced ejection fraction. We sought to test the hypothesis that GLS might be superior to MAPSE as a risk stratification marker in these patients. Methods In total, 1277 ischemic heart failure patients with reduced left ventricular ejection fraction (LVEF<50%), referred to our department between 2009 and 2017, were included in this retrospective study. Offline standard echocardiographic measurements including MAPSE and GLS were performed. Average MAPSE of septal and lateral walls (MAPSE_Avg) was calculated. GLS was derived from the segmental averaging (18-segment) of the three apical views. All patients completed at least one-year clinical follow-up by telephone interview or clinical visit. The primary endpoint was defined as all-cause mortality or heart transplantation (HTx). Results At baseline visit, mean age was 70±11 years and 79.6% were men. NYHA class III-IV were identified in 33.5% of patients. Coronary artery disease was confirmed by coronary angiography. 63.0% patients had a history of myocardial infarction, 32.1% underwent PCI, and 16.8% underwent coronary artery bypass grafting. Over a median follow-up period of 26 (14–39) months, 369 (28.9%) patients died and 5 (0.4%) underwent HTx. Median LVEF was 39% (32–45%), and there were 48.0% patients with LVEF between 40–49%, 32.3% patients with LVEF between 30–49% and 19.7% patients with LVEF <30%. MAPSE_Avg was 8.0 (6.5–10.0) mm and median GLS was −9.9% (−7.7 to −12.3%). Clinical covariates significantly associated with all-cause mortality in this cohort included age (HR=1.048), NYHA class III-IV (HR=1.800), AF (HR=1.567), diabetes (HR=1.262), dyslipidemia (HR=0.657), hyperuricemia (HR=1.861), peripheral vascular disease (HR 1.858), chronic respiratory diseases (HR=1.680), and renal dysfunction (HR=2.705). Multivariable Cox regression analysis showed that reduced MAPSE_Avg (<7mm, HR=1.431, 95% CI 1.146–1.786) and reduced GLS (<8.3%, HR=1.519, 95% CI 1.230–1.875) were independent predictors of all-cause mortality after adjustment of above-mentioned clinical confounders. ROC curves demonstrated that the predictive performance of all-cause mortality among LVEF, MAPSE_Avg, and GLS were similar (AUC=0.608, 0.601, and 0.616, respectively, all P<0.001). Conclusions Both 2DE-guided GLS and MAPSE could provide additional prognostic information in ischemic heart failure patients with reduced LVEF. Prognostic performance of GLS, MAPSE, and LVEF is similar in ischemic heart failure patients with reduced LVEF. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Federal Ministry of Education and Research

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P3551Right ventricular dysfunction in heart failure patients with reduced ejection fraction with and without chronic respiratory diseases: A treacherous combination for the ominous outcome?

European Heart Journal ◽

10.1093/eurheartj/ehz745.0414 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Hu ◽

D Liu ◽

M Kirch ◽

C Scheffold ◽

F Liebner ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Respiratory Diseases ◽

Cox Regression ◽

Right Atrial ◽

Chronic Respiratory Diseases ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

All Cause Mortality ◽

Rv Function

Abstract Background Right ventricular (RV) dysfunction is common in heart failure patients. In the present study, we determined the impact of echocardiography defined RV dysfunction on outcomes in heart failure patients with reduced ejection fraction (<40%, HFrEF) with and without chronic respiratory diseases (CRDs: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome). Methods A total of 1264 HFrEF patients (Mean age: 68±13 years; male: 76.3%) referred to our department between 2009 and 2017 were included. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (12–40) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed by multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP). Results The proportion of NYHA functional class III-IV was 42.2%. Mean LVEF was 29.4±7.0%. CRDs was identified in 276 (21.8%) patients, 399 (30.5%, without CRDs n=290, with CRDs n=109) patients died (n=386) or underwent HTx (n=13). All-cause mortality/HTx was significantly higher in HFrEF patients with CRDs than without CRDs (39.5% vs. 29.4%, P=0.001). Cox regression analysis showed that age, BMI, and other cardiac risk factors and comorbidities including diabetes, atrial fibrillation, coronary artery disease, kidney dysfunction, and anemia were associated with all-cause mortality/HTx (all P<0.05) besides CRDs. Multivariable Cox regression models showed that sPAP (HR 1.016, P<0.001), TAPSE (HR 0.964, P=0.003), RAA (HR 1.030, P<0.001), and RVD (HR 1.029, P<0.001) were independent determinants of all-cause mortality/HTx in HFrEF patients without CRDs, but not in HFrEF patients with CRDs after adjusted for above mentioned confounders. With the cut-off values (sPAP>40mmHg, TAPSE<12mm, RAA>25cm2, and RVD>36mm) derived from the 3rd quartiles, patients without CRDs were further grouped as normal RV function (all 4 parameters normal, n=427); mild to moderate RV dysfunction (1 or 2 parameters abnormal, n=467) and severe RV dysfunction (≥3 parameters abnormal, n=94). Risk of all-cause mortality/HTx was significantly higher in HFrEF patients with severe (51.1%) and mild to moderate RV dysfunction (34.7%) as compared to patients with normal RV function (18.7%, severe vs. normal: HR 1.616, 95% CI 1.232–2.119, P=0.001; mild to moderate vs. normal HR: 2.657, 95% CI 1.845–3.824, P<0.001). Conclusions RV dysfunction is significantly associated with increased all-cause mortality in HFrEF patients without CRDs. Increased sPAP, RAA, RVD and decreased TAPSE are independent determinants of worse outcomes in HFrEF patients without CRDs, but not in HFrEF patients with CRDs.

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P2630Incidence and prognostic impact of new-onset left bundle branch block in patients with heart failure and reduced ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0953 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S L Kristensen ◽

R Roerth ◽

P S Jhund ◽

S Beggs ◽

L Kober ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Left Bundle Branch Block ◽

Bundle Branch Block ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Qrs Duration ◽

New Onset

Abstract Background Cardiac resynchronization therapy (CRT) improves survival in patients with heart failure, reduced ejection fraction (HFrEF) and left bundle branch block (LBBB). However, little is known about the incidence of LBBB in HFrEF and the risk factors for developing this. We addressed these questions in the PARADIGM-HF and ATMOSPHERE trials. Methods We identified 7703 patients with a non-paced rhythm on their baseline ECG, a QRS<130 ms, and at least one follow-up ECG (done at annual visits and end of study). Patients were stratified by baseline QRS duration (≤100 ms - reference; 101–115 ms and 116–129 ms) and followed until development of QRS duration ≥130 ms with a LBBB configuration or latest available ECG. The crude LBBB incidence rate per 100 person-years (py) was identified in the three QRS duration subgroups. Additionally, we examined risk of the primary composite outcome of cardiovascular death or HF hospitalization, and all-cause mortality, in patients with incident LBBB vs. no incident LBBB. Results Overall, 313 of 7703 patients (4%) developed LBBB during a mean follow-up of 2.7 years, yielding an incidence rate of 1.5 per 100 py. The rate ranged from 0.9 in those with QRS ≤100 ms to 4.0 per 100 py in patients with QRS 116–129 ms. Other predictors of incident LBBB included male sex, age, lower LVEF, HF duration and absence of AF. The risk of the primary composite endpoint was higher among those who developed incident LBBB vs no incident LBBB; event rates 13.5 vs 10.0 per 100 py, yielding an adjusted HR of 1.43 (1.05–1.96). For all-cause mortality the corresponding rates were 12.6 vs 7.3 per 100 py; HR 1.55 (1.16–2.07) (Table 1). Table 1. Risk of outcomes according to incident LBBB during follow-up No. events Crude rate per 100py Adjusted* HR (95% CI) HF hospitalization or CV death No incident LBBB 2145 10.0 (9.6–10.4) 1.00 (ref.) Incident LBBB 43 13.5 (10.0–18.2) 1.43 (1.05–1.96) All-cause mortality No incident LBBB 1662 7.3 (6.9–7.6) 1.00 (ref.) Incident LBBB 48 12.6 (9.5–16.7) 1.55 (1.16–2.07) Conclusion Among patients with HFrEF, the annual incidence of new-onset LBBB (and a potential indication for CRT), was around 1.5%, ranging from 1% in those with QRS duration below 100 ms to 4% in those with QRS 116–129 ms. Incident LBBB was associated with a much higher risk of adverse outcomes, highlighting the importance of repeat ECG monitoring in patients with HFrEF. Acknowledgement/Funding Novartis

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Effect of Oral Nitrates on All-Cause Mortality and Hospitalization in Heart Failure Patients with Reduced Ejection Fraction: A Propensity-Matched Analysis

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2017.02.006 ◽

2017 ◽

Vol 23 (4) ◽

pp. 286-292 ◽

Cited By ~ 2

Author(s):

Dilek Ural ◽

Aysen Şimşek Kandemir ◽

Kurtuluş Karaüzüm ◽

Canan Baydemir ◽

İrem Yılmaz Karaüzüm ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

All Cause Mortality

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Global Longitudinal Strain Is a Superior Predictor of All-Cause Mortality in Heart Failure With Reduced Ejection Fraction

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2015.07.013 ◽

2015 ◽

Vol 8 (12) ◽

pp. 1351-1359 ◽

Cited By ~ 138

Author(s):

Morten Sengeløv ◽

Peter Godsk Jørgensen ◽

Jan Skov Jensen ◽

Niels Eske Bruun ◽

Flemming Javier Olsen ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Reduced Ejection Fraction ◽

All Cause Mortality

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Characterisation of the patients with suspected heart failure: experience from the SHEAF registry

Open Heart ◽

10.1136/openhrt-2020-001448 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001448

Author(s):

Pankaj Garg ◽

Ahmed Dakshi ◽

Hosamadin Assadi ◽

Andrew J Swift ◽

Umna Naveed ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Systolic Dysfunction ◽

Diagnostic Algorithm ◽

Preserved Ejection Fraction ◽

Ventricular Systolic Dysfunction ◽

Reduced Ejection Fraction ◽

All Cause Mortality ◽

Failure Experience

ObjectivesTo characterise and risk-stratify patients presenting to a heart failure (HF) clinic according to the National Institute for health and Care Excellence (NICE) algorithm.MethodsThis is an observational study of prospectively collected data in the Sheffield HEArt Failure registry of consecutive patients with suspected HF between April 2012 and January 2020. Outcome was defined as all-cause mortality.Results6144 patients were enrolled: 71% had HF and 29% had no HF. Patients with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) >2000 pg/mL were more likely to have HF than those with NT-proBNP of 400–2000 pg/mL (92% vs 64%, respectively). Frequency of HF phenotypes include: HF with preserved ejection fraction (HFpEF) (33%), HF with reduced ejection fraction (HFrEF) (29%), HF due to valvular heart disease (4%), HF due to pulmonary hypertension (5%) and HF due to right ventricular systolic dysfunction (1%). There were 1485 (24%) deaths over a maximum follow-up of 6 years. The death rate was higher in HF versus no HF (11.49 vs 7.29 per 100 patient-years follow-up, p<0.0001). Patients with HF and an NT-proBNP >2000 pg/mL had lower survival than those with NT-proBNP 400–2000 pg/mL (3.8 years vs 5 years, p<0.0001). Propensity matched survival curves were comparable between HFpEF and HFrEF (p=0.88).ConclusionOur findings support the use by NICE’s HF diagnostic algorithm of tiered triage of patients with suspected HF based on their NT-proBNP levels. The two pathways yielded distinctive groups of patients with varied diagnoses and prognosis. HFpEF is the most frequent diagnosis, with its challenges of poor prognosis and paucity of therapeutic options.

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The differences in the relationship between diastolic dysfunction, selected biomarkers and collagen turn-over in heart failure patients with preserved and reduced ejection fraction

Cardiology Journal ◽

10.5603/cj.a2016.0098 ◽

2017 ◽

Vol 24 (1) ◽

pp. 35-42 ◽

Cited By ~ 4

Author(s):

Błażej Michalski ◽

Przemysław Trzciński ◽

Karolina Kupczyńska ◽

Dawid Miśkowiec ◽

Łukasz Pęczek ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diastolic Dysfunction ◽

Reduced Ejection Fraction ◽

Heart Failure Patients ◽

Turn Over ◽

The Relationship

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Non-Ischemic Heart Failure With Reduced Ejection Fraction Is Associated With Altered Intestinal Microbiota

Circulation Journal ◽

10.1253/circj.cj-17-1285 ◽

2018 ◽

Vol 82 (6) ◽

pp. 1640-1650 ◽

Cited By ~ 16

Author(s):

Themistoklis Katsimichas ◽

Tomohito Ohtani ◽

Daisuke Motooka ◽

Yasumasa Tsukamoto ◽

Hidetaka Kioka ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Intestinal Microbiota ◽

Ischemic Heart ◽

Ischemic Heart Failure ◽

Reduced Ejection Fraction

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Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

European Heart Journal Open ◽

10.1093/ehjopen/oeab046 ◽

2021 ◽

Author(s):

Maria Concetta Pastore ◽

Giulia Elena Mandoli ◽

Alberto Giannoni ◽

Giovanni Benfari ◽

Frank Lloyd Dini ◽

...

Keyword(s):

Heart Failure ◽

Primary Prevention ◽

Ejection Fraction ◽

Nyha Class ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Volume Index ◽

Early Therapy ◽

Reduced Ejection Fraction

Abstract Background This sub-study deriving from a multicenter Italian register (DISCOVER-ARNI) investigated whether sacubitril/valsartan in adjunction of optimal medical therapy(OMT) could reduce the rate of implantable cardioverter-defibrillator(ICD) indications for primary prevention in heart failure with reduced ejection fraction(HFrEF) according to European guidelines indications, and its potential predictors. Methods In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centers were included. Lack of follow-up or speckle tracking data represented exclusion criteria. Demographic, clinical, biochemical and echocardiographic data were collected at baseline and after 6 months from sacubitril/valsartan initiation. Results Of 351 patients, 225(64%) were ICD carriers and 126(36%) were not ICD carriers (of whom 13 had not indication) at baseline. After 6 months of sacubitril/valsartan, among 113 non-ICD carriers despite having baseline left ventricular (LV)EF≤35% and New York Heart Asscociation(NYHA) class=II-III, 69(60%) did not show ICD indications; 44(40%) still fulfilled ICD criteria. Age, atrial fibrillation, mitral regurgitation>moderate, left atrial volume index(LAVi), and LV global longitudinal strain(GLS) significantly varied between the groups. With ROC curves, age≥75 years, LAVi≥42ml/m2 and LV GLS≥-8.3% were associated with ICD indications persistence (AUC=0.65,=0.68,=0.68 respectively). With univariate and multivariate analysis, only LV GLS emerged as significant predictor of ICD indications at follow-up in different predictive models. Conclusions Sacubitril/valsartan may provide early improvement of NYHA class and LVEF, reducing the possible number of implanted ICD for primary prevention in HFrEF. Baseline reduced LV GLS was a strong marker of ICD indication despite OMT. Early therapy with sacubitril/valsartan may save infective/hemorrhagic risks and unnecessary costs deriving from ICDs.

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