Abstract 9116: In Patients with Preserved Ejection Fraction, Newer Measures of Systolic Function Have Better Correlation with Functional Status Than Do Traditional Measures of Diastolic Function
Introduction: Multiple abnormalities in left ventricular (LV) systolic and diastolic function have been demonstrated in patients with heart failure and preserved ejection fraction. We aimed to determine which echocardiographic measures of LV systolic or diastolic function best correlate with functional status in patients with preserved ejection fraction (EF).
Methods: Patients referred for clinically indicated echos who had images adequate for evaluation of regional myocardial function were approached for enrollment. Functional status was determined by the Duke Activity Status Index (DASI), which correlates with peak oxygen uptake. Echos were analyzed by investigators blinded to DASI scores. EF was determined with Simpson's biplane method. Speckle tracking echo (STE) (QLab version 7.1 Philips, The Netherlands) was used to determine peak circumferential, radial, and longitudinal strain for each LV segment. Torsion was defined as the maximal difference between apical and basal twist. Standard Doppler techniques were used to measure peak early (E) and atrial (A) filling velocities as well as peak early velocity (E') of the medial mitral annulus.
Results: 34 patients with an EF ≥ 45% were enrolled. There was no correlation between E/E' and DASI scores (r=0.008, p=0.97, n=24). Whereas, there was a relatively strong correlation between DASI scores and radial strain (r=0.703, p=0.003, n=15). There were moderate correlations between DASI scores and global longitudinal strain (r=-0.54, p=0.038, n=15), global circumferential strain (r=-0.392, p=0.087, n=20) and torsion (r=0.462, p=0.054, n=18). Using a backwards fit technique, a model including global radial strain and torsion provides the best prediction of DASI scores, [DASI score = -9.039 + (2.141×torion) + (1.083× radial strain)], (r= 0.731, p=0.003 n=14).
Conclusions: In our cohort of patients with preserved EF, traditional measures of diastolic function (E/E') had no correlation with functional status. Systolic measures, such as radial strain, correlated the best with functional status. STE derived measures of LV systolic events may be a more appropriate variable than traditional diastolic measures in studies investigating patients with preserved EF.
- © 2011 by American Heart Association, Inc.