Abstract 3052: Relationship Between Subclinical Systolic Dysfunction and Intraventricular Asynchrony in Patients With Heart Failure and Preserved Ejection Fraction
Background: Patients with Heart Failure and preserved Ejection Fraction (HFpEF) often show subtle abnormalities of left ventricular (LV) contractility at analysis of Tissue Doppler (TDI) velocities or deformation indices. The purpose of this study was to determine whether subclinical systolic dysfunction is related to possible presence of systolic asynchrony of the LV in HFpEF patients.
Methods: Patients presenting with HFpEF (n=51; 72±11 years old, 25 men) underwent echocardiographic imaging. A control group of 53 subjects, and another 40 patients with systolic HF (SHF) were included for comparison. Systolic asynchrony was assessed by TDI and defined as >mean+2SD in the control group. TDI-derived longitudinal strain was measured at basal, medium, and apical segments of the 4 LV walls in the apical views, and averaged to obtain a global strain (GS) of the LV. Systolic dysfunction was defined as values below the lower 95% confidence interval of the strain/stress relationship of controls.
Results: Systolic dysfunction by GS was found in 33 patients (65%) with HFpEF and 39 patients (98%) with SHF (p<0.0001). Patients with HFpEF had higher QRS duration compared to controls (103±28 ms vs 83±14 ms, p=0.0003) but lower than SHF (121±33, p=0.0033). In the groups as a whole, mechanical LV asynchrony by TDI was higher in HFpEF patients than in controls (38±29 ms vs 19±9 ms, p=0.0004), but not different than SHF (44±29 ms, p=0.632). At individual level, systolic asynchrony was observed in 9% of controls, 24% of HFpEF patients, and in 58% of SHF (p<0.0001). Considering only the HFpEF group, systolic dysfunction was found in all (100%) HFpEF patients with LV asynchrony, but only in 53% of HFpEF patients without LV asynchrony (p<0.05). In patients with HFpEF intraventricular asynchrony was significantly related to GS (r=0.38, p<0.01), systolic velocities by TDI (r=0.45, p<0.01), and QRS duration (r=0.34, p<0.05), but not to LV mass, volumes, LV relaxation indices or LV filling pressures.
Conclusions: This study shows that systolic asynchrony occurs in about 1/4 of patients with HFpEF, and that it is significantly related to the degree of LV longitudinal dysfunction as assessed by TDI-derived strain analysis.