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. 2012 Jul;33(14):1742-9.
doi: 10.1093/eurheartj/ehs135. Epub 2012 May 29.

Diastolic stiffness as assessed by diastolic wall strain is associated with adverse remodelling and poor outcomes in heart failure with preserved ejection fraction

Tomohito Ohtani  1 , Selma F Mohammed, Kazuhiro Yamamoto, Shannon M Dunlay, Susan A Weston, Yasushi Sakata, Richard J Rodeheffer, Veronique L Roger, Margaret M Redfield
Affiliations

Diastolic stiffness as assessed by diastolic wall strain is associated with adverse remodelling and poor outcomes in heart failure with preserved ejection fraction

Tomohito Ohtani et al. Eur Heart J. 2012 Jul.

Abstract

Aims: The pathophysiology of heart failure with preserved ejection fraction (HFpEF) is complex but increased left ventricular (LV) diastolic stiffness plays a key role. A load-independent, non-invasive, direct measure of diastolic stiffness is lacking. The diastolic wall strain (DWS) index is based on the linear elastic theory, which predicts that impaired diastolic wall thinning reflects resistance to deformation in diastole and thus, increased diastolic myocardial stiffness. The objectives of this community-based study were to determine the distribution of this novel index in consecutive HFpEF patients and healthy controls, define the relationship between DWS and cardiac structure and function and determine whether increased diastolic stiffness as assessed by DWS is predictive of the outcome in HFpEF.

Methods and results: Consecutive HFpEF patients (n = 327, EF ≥ 50%) and controls (n = 528) from the same community were studied. Diastolic wall strain was lower in HFpEF (0.33 ± 0.08) than in controls (0.40 ± 0.07, P < 0.001). Within HFpEF, those with DWS ≤ median (0.33) had higher LV mass index, relative wall thickness, E/e', Doppler-estimated LV end-diastolic pressure to LV end-diastolic volume ratio, left atrial volume index, and brain natriuretic peptide (BNP) levels than those with DWS > median. Heart failure with preserved ejection fraction patients with DWS ≤ median had higher rate of death or HF hospitalization than those with DWS > median (P = 0.003) even after the adjustment for age, gender, log BNP, LV geometry, or log E/e' (P < 0.01).

Conclusion: These data suggest that DWS, a simple index, is useful in assessing diastolic stiffness and that more advanced diastolic stiffness is associated with worse outcomes in HFpEF.

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Figures

Figure 1
Figure 1
Cumulative frequency distribution of diastolic wall strain (DWS) in patients with heart failure and preserved ejection fraction (HFpEF, black solid) and control subjects (dashed).
Figure 2
Figure 2
Event-free survival in heart failure with preserved ejection fraction patients according to diastolic wall strain (DWS). Kaplan–Meier plot of event-free (death or heart failure hospitalization) survival in patients with heart failure and preserved ejection fraction patients with diastolic wall strain above (DWS high, black) and below (DWS low, red) the median value of diastolic wall strain in heart failure with preserved ejection fraction patients.
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