Abstract 11098: Abnormalities of Left Ventricular Systolic Function in Heart Failure with Preserved Ejection Fraction
Background: While diastolic dysfunction is widely considered a key pathophysiologic mediator of heart failure with preserved ejection fraction (HFpEF), concomitant systolic dysfunction despite preserved EF may play a role.
Methods: We assessed myocardial systolic and diastolic function in a contemporary HFpEF clinical trial, PARAMOUNT, which enrolled patients with heart failure, NYHA class II-IV symptoms, an EF ≥ 45% and NT pro-BNP levels > 400 pg/ml [median 894 (IQR 526, 1457)]. Longitudinal and circumferential systolic deformation was assessed in 232 PARAMOUNT patients and compared to 50 healthy controls free of cardiovascular disease (mean age 60 ± 8; 51% female) using a vendor-independent 2D speckle tracking software (TOMTEC). The frequency and severity of impaired deformation was assessed across the spectrum of EF in HFpEF and was correlated with standard measures of diastolic function including E’ and E/E’ and with NT-pro BNP.
Results: Mean age was 71±9 years, 61% were female, 83% white, 92 % hypertensive and 51% had a history of heart failure hospitalization. Mean EF was 58.5 ± 7.6, E/E’ was 16.1 ± 7 and 94 % had diastolic dysfunction ≥ grade I. Compared to healthy controls, HFpEF patients enrolled in PARAMOUNT demonstrated significantly lower longitudinal and circumferential strain across the spectrum of EF although these measures of strain were worse in patients with lower EF (figure 1). Neither longitudinal nor circumferential strain were related to standard echocardiographic measures of diastolic function (E’ or E/E’). However, worse longitudinal strain was significantly, though modestly, associated with higher NT-pro BNP levels, even after adjustment for 10 baseline covariates including EF (correlation coefficient 0.22, p<0.001).
Conclusion: In this contemporary clinical trial, in addition to diastolic dysfunction, HFpEF was characterized by impaired systolic deformation which was associated with higher NT-pro BNP.
- © 2012 by American Heart Association, Inc.