Longitudinal Strain in Heart Failure with Preserved Ejection Fraction: Is There a Role for Prognostication?
Heart failure with preserved ejection fraction (HFpEF) represents approximately 50% of the overall heart failure (HF) population1, yet relatively few prognostic markers are used in routine clinical practice. Clinicians commonly assess symptom severity, prior HF hospitalizations, natriuretic peptide levels and comorbidity burden to characterize disease trajectory. Furthermore, without disease-modifying agents, the management of HFpEF is largely limited to optimization of volume status and comorbid conditions2. In contrast, for patients with HF with reduced EF (HFrEF), clinicians incorporate an array of data from clinical evaluation and diagnostic testing to risk-stratify patients, individualize guideline-based medication regimens and determine optimal timing for implantable devices and advanced therapies. For instance, thresholds for echocardiographic and exercise testing parameters (e.g., EF and maximal oxygen consumption) are central components of the decision-making process for defibrillator implantation and advanced therapies such as ventricular assist devices2. An equivalent prognostic marker to EF has not been identified for HFpEF patients despite the similarly high event rate compared to HFrEF cohorts3, 4.
- Received June 18, 2015.
- Accepted June 25, 2015.