Longitudinal, circumferential and radial systolic left ventricular function in patients with heart failure and preserved ejection fraction.
2016
Introduction: Heart failure with preserved left ventricular
ejection fraction (HFPEF) is an epidemiologically serious
disease. Noninvasive diagnosis of HFPEF remains challenging.
The current diagnosis is based on evidence of diastolic
dysfunction, albeit systolic dysfunction is also present but
not included in the diagnostic algorithm. The aim of this study
was to analyze the longitudinal (long), circumferential (circ)
and radial (rad) component of systolic left ventricular (LV)
function in patients with exertional dyspnea of unexplained
etiology and normal left ventricular ejection fraction (LVEF).
Methods: One hundred and twenty-two patients with exertional
dyspnea of unexplained etiology and normal LVEF and 21 healthy
controls, underwent echocardiography examination at rest and at
the end of symptom-limited exercise. We analysed the
longitudinal, circumferential and radial deformation of
myocardium using two dimensional speckle tracking
echocardiography in all subjects. Results: Patients with
exertional dyspnea and preserved LVEF were divided into group
A1 (46 patients meeting the criteria for the diagnosis HFPEF)
and group A2 (76 patients without HFPEF). Group A1 had
significantly worse longitudinal and circumferential systolic
LV function than group A2. Subjects in group A1 compared to
group A2 showed significantly different strain rates during
atrial contraction (SR A), circ and ratio of peak early
trans-mitral flow velocity (E) and strain rate E wave (E / SR
E) circ. Multivariate logistic regression analysis showed that
the SR parameter A circ is an independent predictor of HFPEF
(odds ratio 0.550, 95% confidence interval: 0.370 - 0.817, P
value 0.003). Conclusion: Longitudinal and circumferential LV
deformation was significantly more impaired in patients with
HFPEF than in patients with exertional dyspnea without HFPEF.
In patients with exertional dyspnea and normal LVEF, the value
of SRA circ appears to be a significant and independent
predictor of HFPEF. This parameter may, in the future
complement the diagnostic algorithm for HFPEF.
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