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. 2023 Aug 23;24(9):1168-1176.
doi: 10.1093/ehjci/jead117.

Association of left ventricular strain-volume loop characteristics with adverse events in patients with heart failure with preserved ejection fraction

Thijs P Kerstens  1   2 , Jerremy Weerts  3 , Arie P J van Dijk  2 , Gert Weijers  4 , Christian Knackstedt  3 , Thijs M H Eijsvogels  1 , David Oxborough  5 , Vanessa P M van Empel  3 , Dick H J Thijssen  1   5
Affiliations

Association of left ventricular strain-volume loop characteristics with adverse events in patients with heart failure with preserved ejection fraction

Thijs P Kerstens et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Patients with heart failure with preserved ejection fraction (HFpEF) are characterized by impaired diastolic function. Left ventricular (LV) strain-volume loops (SVL) represent the relation between strain and volume during the cardiac cycle and provide insight into systolic and diastolic function characteristics. In this study, we examined the association of SVL parameters and adverse events in HFpEF.

Methods and results: In 235 patients diagnosed with HFpEF, LV-SVL were constructed based on echocardiography images. The endpoint was a composite of all-cause mortality and Heart Failure (HF)-related hospitalization, which was extracted from electronic medical records. Cox-regression analysis was used to assess the association of SVL parameters and the composite endpoint, while adjusting for age, sex, and NYHA class. HFpEF patients (72.3% female) were 75.8 ± 6.9 years old, had a BMI of 29.9 ± 5.4 kg/m2, and a left ventricular ejection fraction of 60.3 ± 7.0%. Across 2.9 years (1.8-4.1) of follow-up, 73 Patients (31%) experienced an event. Early diastolic slope was significantly associated with adverse events [second quartile vs. first quartile: adjusted hazards ratio (HR) 0.42 (95%CI 0.20-0.88)] after adjusting for age, sex, and NYHA class. The association between LV peak strain and adverse events disappeared upon correction for potential confounders [adjusted HR 1.02 (95% CI 0.96-1.08)].

Conclusion: Early diastolic slope, representing the relationship between changes in LV volume and strain during early diastole, but not other SVL-parameters, was associated with adverse events in patients with HFpEF during 2.9 years of follow-up.

Keywords: HFpEF; all-cause mortality; heart failure hospitalization; strain–volume loop; survival.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
A schematic overview of the strain–volume loop and the derived characteristics. Solid line: systolic strain–volume relation; dashed line: diastolic strain–volume relation. (a) end diastolic volume; (b) after ejecting 5% of stroke volume; (c) end systolic volume; (d) filling at 5% of stroke volume; (e) filling at two thirds of stroke volume; (f) filling at 95% of stroke volume. ES: early systolic; S: systolic; ED: early diastolic; LD: late diastolic; Uncoup: uncoupling.
Figure 2
Figure 2
Forest plot and hazard ratios for univariable (red) and multivariable (blue) Cox regression analysis. Hazard ratios are plotted on a logarithmic scale. LVEF, left ventricular ejection fraction; ES, early systolic; S, systolic; ED, early diastolic; LD, late diastolic; UNCOUP, uncoupling; ref, reference; Q1, first quartile; CI, confidence interval.
Figure 3
Figure 3
Kaplan–Meier curve for composite endpoint to ED slope divided in quartiles. Vertical lines represent censored patients. ED, early diastolic.
See this image and copyright information in PMC

Comment in

  • Strain-volume loops and cardiac function.
    Gillebert TC. Gillebert TC. Eur Heart J Cardiovasc Imaging. 2023 Aug 23;24(9):1177-1179. doi: 10.1093/ehjci/jead129. Eur Heart J Cardiovasc Imaging. 2023. PMID: 37282734 No abstract available.

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