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Left ventricular global longitudinal strain and free wall strain of the right ventricle in respect to sex and systolic function among patients with acutely decompensated heart failure

Session HFA Discoveries - ePosters

Speaker Josip Andjelo Borovac

Event : HFA Discoveries 2020

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Diagnostic Methods
  • Session type : ePosters

Authors : JA Borovac (Split,HR), Z Susilovic Grabovac (Split,HR), A Bradaric (Split,HR), D Glavas (Split,HR), D Duplancic (Split,HR), J Bozic (Split,HR)

Authors:
JA Borovac1 , Z Susilovic Grabovac1 , A Bradaric1 , D Glavas1 , D Duplancic1 , J Bozic2 , 1University Hospital Center Split, Clinic for Cardiovascular Diseases - Split - Croatia , 2University of Split School of Medicine, Department of Pathophysiology - Split - Croatia ,

On behalf: CATSTAT-HF

Citation:

Background: Heart failure (HF) is currently classified according to left ventricular ejection fraction (LVEF) in three distinct phenotypes whereas novel indices of cardiac function such as global longitudinal strain of the left ventricle (LV GLS) and 2D free wall strain of the right ventricle (2D RV FWS) have shown to provide an additional prognostic value in this population. We aimed to determine the proportion of acutely decompensated heart failure (ADHF) patients that had abnormal LV GLS and 2D RV FWS at index admission and to examine if these indices differ significantly among three HF phenotypes and between men and women.

Methods: A total of 42 consecutive patients with ADHF as adjudicated per ESC 2016 heart failure guidelines were enrolled at our university hospital. LVEF, LV GLS, and 2D RV FWS were measured by the same cardiologist with high expertise in echocardiography and an average of three consecutive measurements was chosen as the final value. Abnormal LV GLS was defined as a value <17% and, among those with abnormal LV GLS, values <17 but >13% were considered as mildly reduced, >8 to 12.9% as moderately reduced and =8% as severely reduced LV GLS. Abnormal 2D RW FWS was defined as a value <23%.

Results:  Patients were on average 67.7±11.8 years of age with mean LVEF of 39.1±15.9 % while both sexes were equally represented (21 women and 21 men). A total of 83.3% (N=35) of patients had abnormal LV GLS whereas 81% (N=34) of patients had abnormal 2D RW FWS. Nearly half of patients had severely reduced strain (47.6%, N=20) with about one-quarter having moderately reduced strain (26.2%, N=11). LV GLS was mildly reduced in 9.5% (N=4) of patients while only 16.7% of patients (N=7) had normal strain values. Mean LV GLS values significantly differed in respect to HF phenotypes (p<0.001) with the following values: 6.93±3.10, 10.38±3.90 and 16.63±4.65 % among patients with LVEF <40%, LVEF 40-49%, and =50%, respectively (Figure 1A). On another hand, mean 2D RW FWS values did not significantly differ among HF phenotypes (p=0.142) with the following values: 15.11±5.91, 18.73±4.45, and 19.68±6.69 % among patients with LVEF <40%, LVEF 40-49% and =50%, respectively (Figure 1B). Finally, LV GLS values did not significantly differ between men and women (9.78±5.88 vs. 10.48±5.18 %, respectively) whereas women had significantly higher 2D RW FWS values compared to men (19.53±6.11 vs. 14.04±4.82 %, p=0.007).
Conclusions: A vast majority of ADHF patients have significantly reduced strains of both left and right ventricle and it seems that these functions worsen according to the LV systolic function. Men seem to have a significantly worse strain of RV compared to women while no such differences were observed in terms of LV GLS. This difference might reflect different pathophysiology and etiology of HF in men compared to women, however, this would require elucidation in further studies.

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