title: Myocardial contractile dysfunction associated with increased 3-month and 1-year mortality in hospitalized patients with heart failure and preserved ejection fraction.
abstract: BACKGROUND
  There is a clinical need for a contractility index that reflects myocardial contractile dysfunction even when ejection fraction (EF) is preserved. We used novel relative load-independent global and regional contractility indices to compare left ventricular (LV) contractile function in three groups: heart failure (HF) with preserved ejection fraction (HFPEF), HF with reduced ejection fraction (HFREF) and normal subjects. Also, we determined the associations of these parameters with 3-month and 1-year mortality in HFPEF patients.
  
  
  METHODS
  199 HFPEF patients [median age (IQR): 75 (67-80) years] and 327 HFREF patients [69 (59-76) years] were recruited following hospitalization for HF; 22 normal control subjects [65 (54-71) years] were recruited for comparison. All patients underwent standard two-dimensional Doppler and tissue Doppler echocardiography to characterize LV dimension, structure, global and regional contractile function.
  
  
  RESULTS
  The median (IQR) global LV contractility index, dσ*/dtmax was 4.30s(-1) (3.51-4.57s(-1)) in normal subjects but reduced in HFPEF [2.57 (2.08-3.64)] and HFREF patients [1.77 (1.34-2.30)]. Similarly, median (IQR) regional LV contractility index was 99% (88-104%) in normal subjects and reduced in HFPEF [81% (66-96%)] and HFREF [56% (41-71%)] patients. Multi-variable logistic regression analysis on HFPEF identified sc-mFS <76% as the most consistent predictor of both 3-month (OR=7.15, p<0.05) and 1-year (OR=2.57, p<0.05) mortality after adjusting for medical conditions and other echocardiographic measurements.
  
  
  CONCLUSIONS
  Patients with HFPEF exhibited decreased LV global and regional contractility. This population-based study demonstrated that depressed regional contractility index was associated with higher 3-month and 1-year mortality in HFPEF patients.
authors: National Heart Centre Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore, Singapore. Electronic address: zhong.liang@nhc.com.sg.
authors: Liang
authors: L
authors: Zhong
authors: Kenneth K C
authors: KK
authors: Ng
authors: Ling Ling
authors: LL
authors: Sim
authors: John Carson
authors: JC
authors: Allen
authors: Yee How
authors: YH
authors: Lau
authors: David K L
authors: DK
authors: Sim
authors: Raymond K K
authors: RK
authors: Lee
authors: Kian Keong
authors: KK
authors: Poh
authors: Terrance S J
authors: TS
authors: Chua
authors: Ghassan S
authors: GS
authors: Kassab
authors: Bernard W K
authors: BW
authors: Kwok
authors: Ru San
authors: RS
authors: Tan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology
keywords: Contractility; Heart failure; Normalized wall-stress; Pathophysiology; Prognosis