Time-Dependent Regional Myocardial Strains in Patients with Heart Failure with a Preserved Ejection Fraction

Objectives. To better understand the etiology of HFpEF in a controlled human population, regional time-varying strains were computed using echocardiography speckle tracking in patients with heart failure with a preserved ejection fraction and normal subjects.Methods. Eleven normal volunteers and ten patients with echo-graded diastolic dysfunction and symptoms of heart failure were imaged with echocardiography and longitudinal, circumferential, and rotational strains were determined using speckle-tracking. Diastolic strain rate was also determined. Patient demographics and echo-derived flows, volumes, and pressures were recorded.Results. Peak longitudinal and circumferential strain was globally reduced in patients (p<0.001), when compared to controls. The patients attained peak longitudinal and circumferential strain at a consistently later point in systole than controls. Rotational strains were not different in most LV regions. Early diastolic strain rate was significantly reduced in the patients (p<0.001). LV mass and wall thickness were significantly increased in the patients; however ejection fraction was preserved and stroke volume was diminished (p<0.001).Conclusions. This study shows that patients with HFpEF have reduced early diastolic strain rate and reduced peak strain that is regionally homogeneous and that they also utilize a longer fraction of systole to achieve peak axial strains.

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Comparison of global and regional myocardial strains in patients with heart failure with a preserved ejection fraction vs hypertension vs age-matched control

Cardiovascular Ultrasound ◽

10.1186/s12947-020-00223-0 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Hyung Yoon Kim ◽

Sung-Ji Park ◽

Sang-Chol Lee ◽

Shin Yi Chang ◽

Eun-Kyoung Kim ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Strain Rate ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Radial Strain ◽

Normal Subjects ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Strain And Strain Rate

Abstract Background With an increasing clinical importance of the treatment of the heart failure (HF) with preserved ejection fraction (HFpEF), it is important to be certain of the diagnosis of HF. We investigated global and regional left ventricular (LV) strains using speckle tracking echocardiography (STE) in patients with HFpEF and compared those parameters with that of patients with hypertension and normal subjects. Methods Peak longitudinal, circumferential and radial strains were assessed globally and regionally for each study groups using STE. Diastolic strain rate was also determined. Results There were 50 patients in HFpEF group, 56 patients in hypertension group and 46 age-matched normal subjects. In patients with HFpEF, global peak longitudinal, circumferential and radial strain and strain rate were reduced compared to both hypertension patients and normal controls (− 15.5 ± 5.3 vs − 17.7 ± 3.1 and − 19.9 ± 2.0; − 9.7 ± 2.2 vs − 19.3 ± 3.1 and − 20.5 ± 3.3; 17.7 ± 8.2 vs 38.4 ± 12.4 and 43.6 ± 11.9, respectively, P < 0.001, for all). The diagnostic performance of global circumferential strain to predict the HFpEF was greatest among strain parameters (area under the curve = 0.997). Conclusions In the speckle tracking echocardiography, impaired peak global strain and homogeneously reduced regional strain was observed in HFpEF patients compared to the hypertension patients and normal subjects in decreasing order. This can provide early information on the initiation of LV deformation of HFpEF in patients with hypertension or normal subjects.

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The feasibility and utilization of tissue doppler imaging, longitudinal and circumferential strain and strain rate in the diagnostic accuracy for heart failure with preserved ejection fraction

European Heart Journal ◽

10.1093/eurheartj/eht308.p2445 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P2445-P2445

Author(s):

W. R. Lan ◽

C. I. Lo ◽

Y. H. Lai ◽

J. Y. Kuo ◽

J. Y. Hou ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diagnostic Accuracy ◽

Strain Rate ◽

Tissue Doppler Imaging ◽

Circumferential Strain ◽

Tissue Doppler ◽

Doppler Imaging ◽

Preserved Ejection Fraction ◽

Strain And Strain Rate

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Left Ventricular Diastolic Dysfunction and Exercise Intolerance in Obese Heart Failure with Preserved Ejection Fraction

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00610.2020 ◽

2021 ◽

Author(s):

T. Jake Samuel ◽

Dalane W. Kitzman ◽

Mark J. Haykowsky ◽

Bharathi Upadhya ◽

Peter Brubaker ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Strain Rate ◽

Left Ventricular ◽

Exercise Intolerance ◽

Peak Exercise ◽

Strain Rates ◽

Preserved Ejection Fraction ◽

Diastolic Strain Rate ◽

Strain And Strain Rate

This study tested the hypothesis that early left ventricular (LV) relaxation is impaired in older obese heart failure with preserved ejection fraction (HFpEF) patients, and related to decreased peak exercise oxygen uptake (peak VO2). LV strain and strain rate were measured by feature tracking of magentic resonance cine images in 79 older obese HFpEF patients (mean age: 66 years; mean BMI: 38 kg/m2) and 54 healthy control participants. LV diastolic strain rates were indexed to cardiac preload as estimated by echocardiography derived diastolic filling pressures (E/e'), and correlated to peak VO2. LV circumferential early diastolic strain rate was impaired in HFpEF compared to controls (0.93±0.05 s-1 vs 1.20±0.07 s-1, p=0.014); however, we observed no group differences in early LV radial or longitudinal diastolic strain rates. Isolating myocardial relaxation by indexing all three early LV diastolic strain rates (i.e. circumferential, radial, and longitudinal) to E/e' amplified the group difference in early LV diastolic circumferential strain rate (0.08±0.03 vs 0.13±0.05, p<0.0001), and unmasked differences in early radial and longitudinal diastolic strain rate. Moreover, when indexing to E/e', early LV diastolic strain rates from all three principal strains, were modestly related with peak VO2 (R=0.36, -0.27, 0.35, respectively, all p<0.01); this response, however, was almost entirely driven by E/e' itself, (R=-0.52, P<0.001). Taken together, we found that while LV relaxation is impaired in older obese HFpEF patients, and modestly correlates with their severely reduced peak exercise VO2, LV filling pressures appear to play a much more important role in determining exercise intolerance.

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