Assessment of Left Ventricular Systolic Function in Heart Failure Patients with Preserved Ejection Fraction by 2D Speckle Tracking Echocardiography
Heart failure is still a chief clinical syndrome impacting health with growing prevalence and incidence rates. Almost half of the patients still have preserved Ejection Fraction (EF). However, they show the same morbidity and mortality as those of reduced EF. EF measurement is counted till now, the reliable estimate for precise assessment of the Left Ventricular (LV) systolic function. However, using strain and strain rate by Speckle Tracking Echocardiography (STE) to estimate Global Longitudinal Strain (GLS) is more accurate for measuring myocardial contractility. Therefore, it has a diagnostic and predictive morbidity and mortality benefit in studying Heart Failure patients with preserved Ejection Fraction (HFpEF) superior to EF estimation alone.
Objectives: To assess the value of 2D STE in evaluating LV systolic function in HFpEF.
Methods: We enrolled in 45 subjects. Fifteen patients with Diastolic Dysfunction (DD) and signs and symptoms of HF (HFpEF group), 15 patients with DD and no signs or symptoms of HF (asymptomatic DD group), and 15 normal subjects matched for age and gender (control group). We screened patients by conventional echocardiography and obtained echocardiography of 4, 2, and 3 chambers views. In HFpEF patients, we correlated clinical, echocardiographic, and biomarker parameters with global longitudinal strain.
Results: HFpEF patients showed significantly higher LVMI than both DD and control groups (P value<0.001 for both). GLS led to significantly lower values in the HFpEF group than in the DD and control groups (p value<0.001 for both). The cutoff point to diagnose HF in DD cases according to GLS was ≤ -16.24 with sensitivity and specificity of 80.0% and 93.33%, respectively, compared to the asymptomatic DD group. The cutoff point in GLS b etween D D c ases a nd c ontrols w as ≤ -19.05 with sensitivity and specificity of 80.0% and 73.33%, respectively. According to univariate analysis, GLS in HF patients was affected by hypertension, DM, and lateral S'.
