Abstract 14217: Enhanced LV Stiffening Assessed by Diastolic Wall Strain is Associated with Poor Prognosis in Patients with Heart Failure and Moderately Reduced Ejection Fraction

Abstract

Objectives: Diastolic wall strain (DWS), an index based on the linear elastic theory and a simple calculation, has been proven to reflect LV stiffening in an animal model and to predict worse outcomes of patients with heart failure and preserved ejection fraction (EF). This study aimed to examine whether DWS could noninvasively provide useful information on prognosis in patients with heart failure and moderately reduced (30-50 %) LVEF (HFmrEF) who have a highly variable clinical course.

Methods: Consecutive 95 patients with HFmrEF (age: 56.3±1.7 yrs, LVEF = 42.5±0.5%) underwent echocardiography and follow-up for HF hospitalization. DWS was calculated by echocardiography as: (LV end-systolic wall thickness - LV end-diastolic wall thickness) / LV wall end-systolic thickness. Patients were stratified with median (0.30) of DWS (HFmrEF with DWS≤median and with DWS>median).

Results: DWS correlated with E/e’ (p=0.02) and logBNP (p=0.01), which is compatible with a close relation between DWS and LV stiffness. LVEF was smaller in DWS≤median than in DWS > median; however there was no difference in other parameters between groups (Table). The incidence of HF hospitalization was higher in DWS≤median than in DWS>median (p=0.003, Figure). Continuous value of DWS also correlated with event rate even after adjusting for age, gender, LVEF and logBNP (DWS 0.01 decrease; p<0.01, HR:1.16, 95%CI:1.06-1.27).

Conclusion: DWS provides useful information on prognosis in patients with HFmrEF. This result inferred that severity of patients with HFmrEF is determined at least partially through LV stiffening.