title: Systolic Strain Abnormalities to Predict Hospital Readmission in Patients With Heart Failure and Normal Ejection Fraction.
abstract: BACKGROUND
  Despite intensive investigation, the pathogenesis of heart failure with normal ejection fraction (HFNEF) remains unclear. We hypothesized that subtle abnormalities of systolic function might play a role, and that abnormal systolic strain and strain rate would provide a marker for adverse outcomes.
  
  
  METHODS
  Patients of new CHF and left ventricular ejection fraction > 50% were included. Exclusion criteria were recent myocardial infarction, severe valvular heart disease, severe left ventricular hypertrophy (septum >1.8 cm), or a technically insufficient echocardiogram. Average peak systolic strain and strain rate were measured using an off-line grey scale imaging technique. Systolic strain and strain rate for readmitted patients were compared with those who remained readmission-free.
  
  
  RESULTS
  One hundred consecutive patients with a 1st admission for HFNEF from January 1, 2004 through December 31, 2007, inclusive, were analyzed. Fifty two patients were readmitted with a primary diagnosis of heart failure. Systolic strain and strain rates were reduced in both study groups compared to controls. However, systolic strain did not differ significantly between the two groups (-11.7% for those readmitted compared with -12.9% for those free from readmission, P = 0.198) and systolic strain rates also were similar (-1.05 s-1versus -1.09 s-1, P = 0.545). E/e' was significantly higher in readmitted patients compared with those who remained free from readmission (14.5 versus 11.0, P = 0.013). E/e' (OR 1.189, 95% CI 1.026-1.378; P = 0.021) was found to be an independent predictor for HFNEF readmission.
  
  
  CONCLUSIONS
  Among patients with new onset HFNEF, SS and SR rates are reduced compared with patients free of HFNEF, but do not predict hospital readmission. Elevated E/e' is a predictor of readmission in these patients.
authors.affiliation: Henry Low Heart Center, Hartford Hospital, Hartford, CT, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Borer
authors.affiliation: Henry Low Heart Center, Hartford Hospital, Hartford, CT, USA.
authors.forename: Aravind
authors.initials: A
authors.lastname: Kokkirala
authors.affiliation: Henry Low Heart Center, Hartford Hospital, Hartford, CT, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: O'Sullivan
authors.affiliation: Henry Low Heart Center, Hartford Hospital, Hartford, CT, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Silverman
keywords: Echocardiography; Heart failure; Outcomes; Strain