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. 2022 Aug;15(8):1380-1387.
doi: 10.1016/j.jcmg.2022.03.007. Epub 2022 May 11.

Improving the Characterization of Stage A and B Heart Failure by Adding Global Longitudinal Strain

Kawa Haji  1 , Quan Huynh  2 , Chiew Wong  3 , Simon Stewart  4 , Melinda Carrington  2 , Thomas H Marwick  5
Affiliations
Free article

Improving the Characterization of Stage A and B Heart Failure by Adding Global Longitudinal Strain

Kawa Haji et al. JACC Cardiovasc Imaging. 2022 Aug.
Free article

Abstract

Background: Current guidelines distinguish stage B heart failure (SBHF) (asymptomatic left ventricular [LV] dysfunction) from stage A heart failure (SAHF) (asymptomatic with heart failure [HF] risk factors) on the basis of myocardial infarction, LV remodeling (hypertrophy or reduced ejection fraction [EF]) or valvular disease. However, subclinical HF with preserved EF may not be identified with these criteria.

Objectives: The purpose of this study was to assess the prediction of incident HF with global longitudinal strain (GLS) in patients with SAHF and SBHF.

Methods: The authors analyzed echocardiograms (including GLS) in 447 patients (age 65 ± 11 years; 77% male) enrolled in a prospective study of HF in individuals at risk of incident HF, with normal or mildly impaired EF (≥40%). Long-term follow-up was obtained via data linkage. Analysis was performed using a competing risks model.

Results: After a median of 9 years of follow-up, 50 (10%) of the 447 patients had new HF admissions, and 87 (18%) died. In multivariable analysis, all imaging variables were independent predictors of HF admissions, including left ventricular ejection fraction (LVEF) (HR: 0.97 [95% CI: 0.94-0.99]), LV mass index (HR: 1.01 [95% CI: 1.00-1.02]), left atrial volume index (HR: 1.02 [95% CI: 1.00-1.05]), and E/e' (HR: 1.05 [95% CI: 1.01-1.24]), incremental to clinical variables (age and Charlson comorbidity score). However, the addition of GLS provided value incremental to both clinical and other echocardiographic parameters (P = 0.004). Impaired GLS (<18%) (HR: 4.09 [95% CI: 1.87-8.92]) was independent and incremental to all clinical and other echocardiographic variables in predicting HF, and impaired LVEF, left ventricular hypertrophy, left atrial enlargement, high E/e', or SBHF were not predictive.

Conclusions: The inclusion of GLS as a criterion for SBHF would add independent and incremental information to standard markers of SBHF for the prediction of subsequent HF admissions.

Keywords: heart failure; outcomes; risk factors; stage B heart failure; strain.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Marwick receives grant funding from AstraZeneca and Applied Therapeutics (studies of SBHF in diabetes mellitus) and GE Healthcare (studies of cardiotoxicity using strain imaging). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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