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Left ventricular strain-volume loops and diastolic dysfunction in suspected heart failure with preserved ejection fraction.

Kerstens, TP, Weerts, J, van Dijk, APJ, Weijers, G, Knackstedt, C, Eijsvogels, TMH, Oxborough, D, van Empel, VPM and Thijssen, DHJ (2023) Left ventricular strain-volume loops and diastolic dysfunction in suspected heart failure with preserved ejection fraction. International Journal of Cardiology, 378. pp. 144-150. ISSN 1874-1754

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Open Access URL: https://doi.org/10.1016/j.ijcard.2023.01.084 (Published version)


BACKGROUND: Presence of left ventricular diastolic dysfunction (DD) is key in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). However, non-invasive assessment of diastolic function is complex, cumbersome, and largely based on consensus recommendations. Novel imaging techniques may help detecting DD. Therefore, we compared left ventricular strain-volume loop (SVL) characteristics and diastolic (dys-)function in suspected HFpEF patients.
METHOD AND RESULTS: 257 suspected HFpEF patients with sinus rhythm during echocardiography were prospectively included. 211 patients with quality-controlled images and strain and volume analysis were classified according to the 2016 ASE/EACVI recommendations. Patients with indeterminate diastolic function were excluded, resulting in two groups: normal diastolic function (control; n = 65) and DD (n = 91). Patients with DD were older (74.8 ± 6.9 vs. 68.5 ± 9.4 years, p < 0.001), more often female (88% vs 72%, p = 0.021), and more often had a history of atrial fibrillation (42% vs. 23%, p = 0.024) and hypertension (91% vs. 71%, p = 0.001) compared to normal diastolic function. SVL analysis showed a larger uncoupling i.e., a different longitudinal strain contribution to volume change, in DD compared to controls (0.556 ± 1.10% vs. -0.051 ± 1.14%, respectively, P < 0.001). This observation suggests different deformational properties during the cardiac cycle. After adjustment for age, sex, history of atrial fibrillation and hypertension, we found an adjusted odds ratio of 1.68 (95% confidence interval 1.19-2.47) for DD per unit increase in uncoupling (range: -2.95-3.20).
CONCLUSION: Uncoupling of the SVL is independently associated with DD. This might provide novel insights in cardiac mechanics and new opportunities to assess diastolic function non-invasively.

Item Type: Article
Uncontrolled Keywords: Diastolic dysfunction; Echocardiography; Speckle tracking imaging; Strain volume loop; 1102 Cardiorespiratory Medicine and Haematology; 1117 Public Health and Health Services; Cardiovascular System & Hematology
Subjects: R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions: Sport & Exercise Sciences
Publisher: Elsevier
SWORD Depositor: A Symplectic
Date Deposited: 01 Mar 2023 12:56
Last Modified: 05 Apr 2023 09:00
DOI or ID number: 10.1016/j.ijcard.2023.01.084
URI: https://researchonline.ljmu.ac.uk/id/eprint/19013
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