title: Global strain rate imaging for the estimation of diastolic function in HFNEF compared with pressure-volume loop analysis.
abstract: OBJECTIVE
  Strain rate imaging provides direct information on intrinsic myocardial function and may improve the diagnostic of diastolic dysfunction in heart failure with normal ejection fraction (HFNEF). We therefore correlated global strain with pressure-volume (PV) loop analysis and compared it with flow and tissue Doppler measurements.
  
  
  RESULTS
  Longitudinal two-dimensional strain rate and flow and tissue Doppler (TDI) indices were measured simultaneously and correlated with diastolic indices of PV relationship obtained by a conductance catheter in 21 patients with HFNEF and 12 controls. HFNEF patients showed a reduced global strain rate during isovolumetric relaxation (SR(IVR)) [0.27 (0.12-0.39) vs. 0.44 (0.29-0.56) s(-1), P = 0.028]. Global strain rate during early (SR(E)) and late (SR(L)) diastole did not defer from controls. Their ratios with early transmitral flow, E/SR(IVR) and E/SR(E), were both elevated in HFNEF [3.68 (2.57-7.52) vs. 1.73 (1.47-2.37) m, P = 0.007 and 1.13 (0.76-1.36) vs. 0.83 (0.57-1.04) m, P = 0.030]. SR(E) and SR(IVR) correlated with left ventricular (LV) relaxation τ (r = 0.40 and 0.47, P < 0.05); E/SR(IVR) and E/SR(E) with LV end-diastolic pressure (r = 0.49 and 0.57, P < 0.01) and LV stiffness constant β (r = 0.42 and 0.43, P < 0.01). Neither of the strain rate indices were significantly more accurate than TDI (area under the curve: SR(E) 0.55, SR(IVR) 0.70, E'/A' 0.72, E/SR(E) 0.75, E/SR(IVR) 0.80, and E/E' 0.83).
  
  
  CONCLUSIONS
  Strain rate imaging is accurate in detecting increased LV stiffness in HFNEF, but it is not superior to already established TDI analysis including E/E' in patients with only mild degree of disease.
authors.affiliation: Department of Cardiology and Pneumology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
authors.forename: Mario
authors.initials: M
authors.lastname: Kasner
authors.forename: Regina
authors.initials: R
authors.lastname: Gaub
authors.forename: David
authors.initials: D
authors.lastname: Sinning
authors.forename: Dirk
authors.initials: D
authors.lastname: Westermann
authors.forename: Paul
authors.initials: P
authors.lastname: Steendijk
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hoffmann
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schultheiss
authors.forename: Carsten
authors.initials: C
authors.lastname: Tschöpe
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology; D006328:Cardiac Catheterization / Q000379:methods; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology