Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial

Background While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Methods and results Patients enrolled in the RELAX trial of sil...

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Bibliographic Details
Published in:European journal of heart failure 2017-07, Vol.19 (7), p.893-900
Main Authors: DeVore, Adam D., McNulty, Steven, Alenezi, Fawaz, Ersboll, Mads, Vader, Justin M., Oh, Jae K., Lin, Grace, Redfield, Margaret M., Lewis, Gregory, Semigran, Marc J., Anstrom, Kevin J., Hernandez, Adrian F., Velazquez, Eric J.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biomarkers - blood
Double-Blind Method
Echocardiography
Exercise Tolerance - physiology
Female
Follow-Up Studies
Heart failure
Heart Failure, Systolic - blood
Heart Failure, Systolic - diagnosis
Heart Failure, Systolic - physiopathology
Heart Ventricles - diagnostic imaging
Heart Ventricles - physiopathology
Humans
Male
Middle Aged
Myocardial Contraction - physiology
Natriuretic Peptide, Brain - blood
Oxygen Consumption
Peptide Fragments - blood
Procollagen - blood
Quality of Life
Retrospective Studies
Strain
Stroke Volume - physiology
Time Factors
Ventricular Function, Left - physiology
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Summary:Background While abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. Methods and results Patients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two‐dimensional, speckle‐tracking LV GLS was possible (n = 187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was −14.6% (25th and 75th percentile, −17.0% and −11.9%, respectively) and abnormal (≥ − 16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) [median 505 pg/mL (161, 1065) vs. 875 pg/mL (488, 1802), P = 0.008) and lower collagen III N‐terminal propeptide (PIIINP) levels [median 6.7 µg/L (5.1, 8.1) vs. 8.1 µg/L (6.5, 10.5), P = 0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log‐transformed NT‐proBNP and PIIINP (r = 0.29, P 
ISSN:1388-9842
1879-0844
DOI:10.1002/ejhf.754