title: Impaired systolic function by strain imaging in heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  This study sought to determine the frequency and magnitude of impaired systolic deformation in heart failure with preserved ejection fraction (HFpEF).
  
  
  BACKGROUND
  Although diastolic dysfunction is widely considered a key pathophysiologic mediator of HFpEF, the prevalence of concomitant systolic dysfunction has not been clearly defined.
  
  
  METHODS
  We assessed myocardial systolic and diastolic function in 219 HFpEF patients from a contemporary HFpEF clinical trial. Myocardial deformation was assessed using a vendor-independent 2-dimensional speckle-tracking software. The frequency and severity of impaired deformation was assessed in HFpEF, and compared to 50 normal controls free of cardiovascular disease and to 44 age- and sex-matched hypertensive patients with diastolic dysfunction (hypertensive heart disease) but no HF. Among HFpEF patients, clinical, echocardiographic, and biomarker correlates of left ventricular strain were determined.
  
  
  RESULTS
  The HFpEF patients had preserved left ventricular ejection fraction and evidence of diastolic dysfunction. Compared to both normal controls and hypertensive heart disease patients, the HFpEF patients demonstrated significantly lower longitudinal strain (LS) (-20.0 ± 2.1 and -17.07 ± 2.04 vs. -14.6 ± 3.3, respectively, p < 0.0001 for both) and circumferential strain (CS) (-27.1 ± 3.1 and -30.1 ± 3.5 vs. -22.9 ± 5.9, respectively; p < 0.0001 for both). In HFpEF, both LS and CS were related to LVEF (LS, R = -0.46; p < 0.0001; CS, R = -0.51; p < 0.0001) but not to standard echocardiographic measures of diastolic function (E' or E/E'). Lower LS was modestly associated with higher NT-proBNP, even after adjustment for 10 baseline covariates including LVEF, measures of diastolic function, and LV filling pressure (multivariable adjusted p = 0.001).
  
  
  CONCLUSIONS
  Strain imaging detects impaired systolic function despite preserved global LVEF in HFpEF that may contribute to the pathophysiology of the HFpEF syndrome. (LCZ696 Compared to Valsartan in Patients With Chronic Heart Failure and Preserved Left-ventricular Ejection Fraction; NCT00887588).
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kraigher-Krainer
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Angela
authors.initials: A
authors.lastname: Santos
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: Medical University Graz, Graz, Austria.
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.affiliation: RHJ Department of Veterans Affairs, Medical Center and Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.affiliation: University of Groningen, Groningen, the Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Novartis Pharmaceuticals, East Hanover, New Jersey.
authors.forename: Marty P
authors.initials: MP
authors.lastname: Lefkowitz
authors.affiliation: University of Texas Southwestern, Dallas, Texas.
authors.forename: Milton
authors.initials: M
authors.lastname: Packer
authors.affiliation: University of Glasgow, Glasgow, United Kingdom.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: ssolomon@rics.bwh.harvard.edu.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000613:Aminobutyrates / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001713:Biphenyl Compounds; D004338:Drug Combinations; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology / Q000648:ultrastructure; D006801:Humans; D008297:Male; D008875:Middle Aged; D015260:Neprilysin / Q000037:antagonists & inhibitors; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013777:Tetrazoles / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000613:Aminobutyrates; D047228:Angiotensin II Type 1 Receptor Blockers; D001713:Biphenyl Compounds; D004338:Drug Combinations; D013777:Tetrazoles; D000068756:Valsartan; D015260:Neprilysin; D014633:Valine; C549068:sacubitril and valsartan sodium hydrate drug combination
keywords: CS; HF; HFpEF; HHD; LA; LAVi; LS; LV; LVEF; N-terminal pro-brain natriuretic peptide; NT-proBNP; RWT; cardiac biomarkers; circumferential strain; diastolic heart failure; echocardiography; heart failure; heart failure with preserved ejection fraction; hypertensive heart disease; left atrial; left atrial volume index; left ventricular; left ventricular ejection fraction; longitudinal strain; mechanics; relative wall thickness; systolic strain