Prediction of clinical outcomes based on phenotypic grouping using dual-chamber strains in patients with HFpEF
J H Park, G Y Cho, I W Seong, J H LeeAbstract
Background
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with poor clinical outcomes similar to HF with reduced ejection fraction.
Purpose
We investigated whether phenotyping based on dual-chamber strain analysis (left ventricular global longitudinal strain [LVGLS] and left atrial reservoir strain [LARS]) provides incremental prognostic value in patients with HFpEF.
Methods
We analyzed dual-chamber strains from all HFpEF patients in the multicenter STRATS-AHF registry. We categorized all patients into four groups according to cut-off values (LVGLS≤-16%; LARS³20%). The primary outcome was 5-year all-cause mortality.
Results
We analyzed a total of 1,184 HFpEF patients (mean age: 73.4 years, 60.4% female) and categorized them into four groups: Group 1 (preserved dual-chamber strains, n=304), Group 2 (impaired LVGLS/preserved LARS, n=187), Group 3 (preserved LVGLS/impaired LARS, n=219), and Group 4 (impaired dual-chamber strains, n=474). Compared with Group 1, Group 4 exhibited the highest prevalence of atrial fibrillation (AF, 58.7%), the highest E/E' ratio, and the most impaired right ventricular global longitudinal strain. In univariate analysis, mortality risk increased progressively from Group 2 to group 4 (group 2: HR=1.621, P=0.002; group 3: 1.936, P<0.001; group 4: HR=2.175, P<0.001). In multivariate models, Group 2 (adjusted HR=1.677, P=0.018) and Group 4 (adjusted HR=1.722, P=0.017) remained independent predictors of death compared to Group 1. Group 3 demonstrated attenuated risk after adjusting for other variables, including age and AF (adjusted HR=1.459, P=0.164).
Conclusions
Combined LV and LA strain assessment identified distinct HFpEF phenotypes and provided valuable prognostic information in HFpEF patients.Figure 1