Myocardial strain for heart failure with preserved ejection fraction but without diastolic dysfunction

Aims Some patients with apparent heart failure (HF) have an ejection fraction (EF) >= 50% and elevated levels of natriuretic peptides (NPs), but no significant diastolic dysfunction. Among these, some may have HF, others may not. Myocardial strain is an excellent prognostic factor. Methods and results Among 4312 consecutive patients with acute HF from three tertiary hospitals, we included 355 patients with EF of >= 50% and elevated levels of NPs, without significant diastolic dysfunction. Patients were classified as having impaired global longitudinal strain (GLS < 16%) or normal GLS (GLS > 16%). The primary endpoint was 5 year all-cause mortality. The mean age was 70.3 years and 49% were female. Overall, 107 patients (30.1%) died at 5 years. As per the definition, 176 (49.6%) patients had impaired GLS and 179 (50.4%) had normal GLS. Patients with normal GLS had lower 5 year all-cause mortality than those with impaired GLS (P < 0.001). When comparing with the 11 365 age-matched and sex-matched controls, patients with normal GLS had the same long-term survival as the controls (P = 0.834), whereas those with impaired GLS had 48% increased risk of all-cause mortality (hazard ratio, 1.48; 95% confidence interval, 1.17-1.89). Conclusions Among patients with apparent HF and preserved EF but without diastolic dysfunction, those with impaired GLS may be considered to have HF.

Automated summary

Myocardial strain is a key prognostic factor for patients with apparent HF and preserved EF. Among these patients, those with impaired GLS have higher 5-year all-cause mortality compared to those with normal GLS. Patients with impaired GLS also have a significantly increased risk of all-cause mortality compared to age-matched and sex-matched controls.