Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: Insights from the RELAX trial

Adam D. Devore, Steven Mcnulty, Fawaz Alenezi, Mads Ersboll, Justin M. Vader, Jae Kuen Oh, Grace D Lin, Margaret May Redfield, Gregory Lewis, Marc J. Semigran, Kevin J. Anstrom, Adrian F. Hernandez, Eric J. Velazquez

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Background: While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Methods and results: Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n=187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥-16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505pg/mL (161, 1065) vs. 875pg/mL (488, 1802), P=0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7μg/L (5.1, 8.1) vs. 8.1μg/L (6.5, 10.5), P=0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r=0.29, P<0.001 and r=0.19, P=0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. Conclusions: Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome.

Original languageEnglish (US)
JournalEuropean Journal of Heart Failure
DOIs
StateAccepted/In press - 2017

Fingerprint

Heart Failure
Collagen
Brain Natriuretic Peptide
Stroke Volume
Biomarkers
Quality of Life
Exercise
Left Ventricular Function
Carbon Dioxide
Oxygen Consumption
Ventilation

Keywords

  • Echocardiography
  • Heart failure
  • Strain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction : Insights from the RELAX trial. / Devore, Adam D.; Mcnulty, Steven; Alenezi, Fawaz; Ersboll, Mads; Vader, Justin M.; Oh, Jae Kuen; Lin, Grace D; Redfield, Margaret May; Lewis, Gregory; Semigran, Marc J.; Anstrom, Kevin J.; Hernandez, Adrian F.; Velazquez, Eric J.

In: European Journal of Heart Failure, 2017.

Research output: Contribution to journalArticle

Devore, Adam D. ; Mcnulty, Steven ; Alenezi, Fawaz ; Ersboll, Mads ; Vader, Justin M. ; Oh, Jae Kuen ; Lin, Grace D ; Redfield, Margaret May ; Lewis, Gregory ; Semigran, Marc J. ; Anstrom, Kevin J. ; Hernandez, Adrian F. ; Velazquez, Eric J. / Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction : Insights from the RELAX trial. In: European Journal of Heart Failure. 2017.
@article{17a4b84110af4d59b8d16314f15092ac,
title = "Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: Insights from the RELAX trial",
abstract = "Background: While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Methods and results: Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50{\%}) in whom two-dimensional, speckle-tracking LV GLS was possible (n=187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6{\%} (25th and 75th percentile, -17.0{\%} and -11.9{\%}, respectively) and abnormal (≥-16{\%}) in 122/187 (65{\%}) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505pg/mL (161, 1065) vs. 875pg/mL (488, 1802), P=0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7μg/L (5.1, 8.1) vs. 8.1μg/L (6.5, 10.5), P=0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r=0.29, P<0.001 and r=0.19, P=0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. Conclusions: Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome.",
keywords = "Echocardiography, Heart failure, Strain",
author = "Devore, {Adam D.} and Steven Mcnulty and Fawaz Alenezi and Mads Ersboll and Vader, {Justin M.} and Oh, {Jae Kuen} and Lin, {Grace D} and Redfield, {Margaret May} and Gregory Lewis and Semigran, {Marc J.} and Anstrom, {Kevin J.} and Hernandez, {Adrian F.} and Velazquez, {Eric J.}",
year = "2017",
doi = "10.1002/ejhf.754",
language = "English (US)",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction

T2 - Insights from the RELAX trial

AU - Devore, Adam D.

AU - Mcnulty, Steven

AU - Alenezi, Fawaz

AU - Ersboll, Mads

AU - Vader, Justin M.

AU - Oh, Jae Kuen

AU - Lin, Grace D

AU - Redfield, Margaret May

AU - Lewis, Gregory

AU - Semigran, Marc J.

AU - Anstrom, Kevin J.

AU - Hernandez, Adrian F.

AU - Velazquez, Eric J.

PY - 2017

Y1 - 2017

N2 - Background: While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Methods and results: Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n=187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥-16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505pg/mL (161, 1065) vs. 875pg/mL (488, 1802), P=0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7μg/L (5.1, 8.1) vs. 8.1μg/L (6.5, 10.5), P=0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r=0.29, P<0.001 and r=0.19, P=0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. Conclusions: Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome.

AB - Background: While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Methods and results: Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n=187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥-16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505pg/mL (161, 1065) vs. 875pg/mL (488, 1802), P=0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7μg/L (5.1, 8.1) vs. 8.1μg/L (6.5, 10.5), P=0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r=0.29, P<0.001 and r=0.19, P=0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope. Conclusions: Impaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome.

KW - Echocardiography

KW - Heart failure

KW - Strain

UR - http://www.scopus.com/inward/record.url?scp=85012255169&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85012255169&partnerID=8YFLogxK

U2 - 10.1002/ejhf.754

DO - 10.1002/ejhf.754

M3 - Article

C2 - 28194841

AN - SCOPUS:85012255169

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

ER -