title: Left ventricular global longitudinal strain is associated with exercise capacity in failing hearts with preserved and reduced ejection fraction.
abstract: OBJECTIVE
  Heart failure patients with reduced and preserved left ventricular (LV) ejection fraction (EF) show reduced exercise capacity. We explored the relationship between exercise capacity and systolic and diastolic myocardial function in heart failure patients.
  
  
  RESULTS
  Exercise capacity, by peak oxygen uptake (VO2), was assessed in 100 patients (56 ± 12 years, NYHA functional class: 2.5 ± 0.9, EF: 42 ± 19%). LV systolic function, as EF and global longitudinal strain (GLS), and right ventricular function were assessed by echocardiography. Left atrial volume index and the ratio of peak early diastolic filling velocity (E) to early diastolic mitral annular velocity (e') were measures of diastolic function. Thirty-seven patients had heart failure with preserved EF (HFpEF), defined as EF ≥50% and echocardiographic diastolic dysfunction. LV GLS and peak pulmonary arterial systolic pressure were independently correlated to peak VO2 in the total study population and in HFpEF separately. LV GLS was superior to EF in identifying patients with impaired peak VO2 <20 mL/kg/min as shown by receiver operating characteristic analyses [areas under curves 0.93 (0.89-0.98) vs. 0.85 (0.77-0.93), P < 0.05]. In patients with HFpEF, GLS was reduced below normal (-17.5 ± 3.2%) and correlated to E/e' (R = 0.45, P = 0.005) and left atrial volume index (R = 0.48, P = 0.003), while EF did not.
  
  
  CONCLUSIONS
  GLS correlated independently to peak VO2 in patients with reduced and preserved EF and was superior in identifying patients with reduced exercise capacity. In HFpEF, systolic function by GLS was impaired. There was a significant relationship between diastolic function and GLS, confirming a coupling between diastolic and longitudinal systolic function in HFpEF.
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway Institute for Surgical Research, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Nina E
authors.initials: NE
authors.lastname: Hasselberg
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway Institute for Surgical Research, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Kristina H
authors.initials: KH
authors.lastname: Haugaa
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway Institute for Surgical Research, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Sebastian I
authors.initials: SI
authors.lastname: Sarvari
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway.
authors.forename: Arne K
authors.initials: AK
authors.lastname: Andreassen
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway Institute for Surgical Research, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
authors.forename: Otto A
authors.initials: OA
authors.lastname: Smiseth
authors.affiliation: Department of Cardiology, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway Center for Cardiological Innovation, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway Institute for Surgical Research, Rikshospitalet, Oslo University Hospital, Oslo, Norway thor.edvardsen@medisin.uio.no.
authors.forename: Thor
authors.initials: T
authors.lastname: Edvardsen
mesh_terms: D003430:Cross-Sectional Studies; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: diastolic function; exercise testing; heart failure; myocardial mechanics; speckle tracking echocardiography