Assessment of Function of the Left Heart Myocardium by Tissue Doppler Imaging and Speckle Tracking Echocardiography in Patients with Chronic Heart Failure with Preserved Left Ventricular Ejection Fraction

Abstract

Aim: to study myocardial function in patients with chronic heart failure (CHF) with preserved left ventricular ejection fraction (PEF) by speckle tracking echocardiography and tissue doppler imaging.

Materials and methods: We examined 80 patients aged 50-70 years with verified NYHA class I-IIa CHF and PEF due to arterial hypertension and ischemic heart disease, and 35 healthy persons. Examination included echocardiography, and speckle-tracking echocardiography.

Results: According to 6-min walk test 26.9 % of patients had functional class (FC) I CHF, 48.3 % - FC II CHF, and 24.8 - FC III CHF. The mean left ventricular ejection fraction (Simpson's method) was 62.3±5.35 %, mean end systolic left atrial volume index - 45±8.1 ml / m2. All patients had left ventricular diastolic dysfunction: 60 patients - abnormal relaxation pattern, 20 patients - pseudonormal pattern. Other findings were reduced global longitudinal strain (GLS, -16.56±2.61 %) and GLS rate (GLSR, -0.75±0.11 s-1) of the left ventricle and reduced segmental strain and strain rate in basal anteroseptal (-13.62±3.44 % and -0.77±0.04 s-1, respectively) and basal anterolateral (-14.17±3.31 % and -0.81±0.11 s-1, respectively) segments. Lowering of global circular left ventricular strain and strain rate (-15.63±4.8% and -1.4±0.23 s-1, respectively) was found to be smaller than that of GLS (p<0.05). There was positive correlation between left ventricular systolic GLS and left atrial volume (r=0.601, р<0.01).

Conclusions: In patients with CHF and PEF we revealed alterations of diastolic function (abnormal relaxation and pseudonormal patterns), reductions of global and segmental strain and strain rate of the left ventricle. More pronounced lowering of segmental strain and strain rate was registered in left ventricular basal anteroseptal and basal anterolateral segments. Circular strain was found to be slightly reduced, while radial strain was unchanged.