Heart failure with preserved ejection fraction in the elderly: clinical, imaging, and biomarker profiles according to global longitudinal strain by cardiac magnetic resonance
M Garcia Melero, P L Pau Llacer, B Beatriz Del Hoyo, C Perez Medina, J Campos, F Croset, N Perez, E PisonAbstract
Background
Heart failure with preserved ejection fraction (HFpEF) is highly prevalent in older adults, yet conventional imaging fails to capture early myocardial dysfunction. global longitudinal strain (GLS), particularly assessed by cardiac magnetic resonance (CMR), may identify subclinical abnormalities and improve risk stratification in this population. The aim of this study is to evaluate the clinical, imaging, and biomarker profiles of elderly patients with HFpEF according to GLS measured by CMR, and secondarily, to examine its prognostic significance.
Methods
In this prospective single-center study, 37 elderly patients (median age 87) with HFpEF (LVEF >40%) underwent comprehensive assessment including clinical, echocardiography, CMR-derived GLS, and biomarker evaluation. Patients were categorized into reduced (≥–16.8%) or normal GLS (<–16.8%). Associations with clinical characteristics, echocardiographic parameters, biomarkers, and outcomes were analyzed. The primary objective was to characterize clinical, biomarker, and imaging profiles according to GLS group. Secondary objectives included assessing the association between GLS and adverse clinical outcomes.
Results
Impaired GLS was present in 46% of patients and associated with lower eGFR, subclinical systolic dysfunction, greater NYHA class, and more clinical signs of congestion. Among patients with LVEF ≥50%, 35.5% showed abnormal GLS. Impaired GLS independently predicted the combined endpoint (heart failure hospitalizations or all-cause mortality) (HR 1.15, 95% CI: 1.02–1.29, p=0.020) and heart failure hospitalization, but not mortality.
Conclusions
In elderly HFpEF patients, CMR-derived GLS identifies a distinct high-risk phenotype with greater hemodynamic burden and higher risk of decompensation. GLS may improve risk stratification and guide tailored management strategies in this underrepresented population.Kaplan–Meier plotsFor image description, please refer to the figure legend and surrounding text.Kaplan–Meier curvesFor image description, please refer to the figure legend and surrounding text.