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Association between HFpEF and Impaired Left Heart strain in Hypertensive Heart Disease: Evaluation by Cardiac MRI Feature Tracking1Graduate School of Dalian Medical University, Dalian Municipal Central Hospital, Dalian, China, 2The Affiliated Hospital of Dalian University of Technology, Dalian Municipal Central Hospital, Dalian, China
Synopsis
Keywords: Heart, Hypertension, Heart failure LA/LV strain
The application value of left atrial and left ventricular strain parameters to heart failure with preserved left ventricular ejection fraction in hypertensive heart disease was evaluated by cardiac magnetic resonance feature tracking technology. We found that the left atrial function, strain, and left ventricular strain parameters were impaired to varying degrees in the HFpEF-HHD group, and the left atrial ejection fraction was significantly correlated with some feature parameters of left atrial and left ventricular strain. However, NT-proBNP is only significantly correlated with LAεa.In the identification of the HFpEF-HHD population, the LASRe parameter has shown optimal diagnostic value.Background
The majority of heart failure (HF) in hypertensive heart disease (HHD) manifests as a phenotype with preserved left ventricular (LV) ejection fraction（HFpEF）. The exact contribution of left atrial (LA) phasic strain to HFpEF-HHD remains unresolved and compared with the left ventricular strain parameters, which strain parameters can identify HFpEF-HHD earlier is still unknown.Purpose
Quantitative evaluation of left atrial and left ventricular strain parameters for heart failure with preserved ejection fraction in hypertensive heart disease patients (HFpEF-HHD) by CMR⁃FT technique, and determine the optimal strain parameters of HFpEF-HHD in early detection.Methods
25 cases of HFPEF-HHD, 25 cases of HHD, and 23 cases of the healthy control group were retrospectively collected. All patients received NT-proBNP detection and cardiac magnetic resonance (CMR) examination. CVI42 cardiac post-processing software was used to measure the left heart function of the three groups of patients, including Left atrial Total ejection fraction (LAEFTotal), passive ejection fraction (EFPassive), Booster ejection fraction (EFBooster), left ventricular ejection fraction (LVEF) and strain module measurements: LA reservoir(εs), conduit(εe), booster pump(εa)strain and strain rate(SRs, SRe, SRa), left ventricular global peak strain and strain rate.The differences in cardiac function and strain parameters among the three groups were compared, and the correlation between left atrial and left ventricular strain parameters and LAEF, LVEF, and NT-proBNP was analyzed. The optimum strain parameters of HFpEF-HHD were identified by the receiver operating characteristic curve.Results
Compared to the differences in cardiac function and strain parameters among the three groups (shown in Table 1), the left atrial ejection fraction and strain (except εa) of the HFpEF-HHD group were significantly impaired. Left ventricular global peak longitudinal strain (GPLS), global peak circumferential strain (GPCS), systolic global peak longitudinal strain rate (sGPLSR), and diastolic global peak strain rate (eGPLSR) were impaired. Compared with the HHD group, there were significant differences in LAEF Total, EFPassive, LA strain (except εa), and LVGPLS, sGPLSR, eGPLSR in the HFpEF-HHD group (p < 0.05). Compared with the healthy control group, there were significant differences in all of LAEF, LA strain (except εa), and LV GPLS, GPCS, sGPLSR, eGPLSR in the HFpEF-HHD group.LAEF Total and Booster were significantly correlated with εs, εe, εa, and GPLS (p < 0.05), LAEF Passive was significantly correlated with εs, εe, GPLS, and GPCS (p < 0.05), and LVEF was significantly correlated with εa and GPLS (p < 0.05).NT-proBNP was significantly correlated with LAεa (p < 0.05) (shown in Table 2).
Strain parameters were used to distinguish the HFpEF-HHD group from the healthy control group, LAεs, εe, SRs, SRe, SRa, LV GPLS, GPCS, sGPLSR, and eGPLSR have diagnostic value (shown in Table 3).LASRe has the highest diagnostic efficiency with cut-off value of −1.15s-1 (shown in Fig.1).
Conclusions
Left atrial function and strain parameters are generally impaired in patients with HFpEF-HHD, and LASRe can detect microscopic changes in HFpEF-HHD earlier than left ventricular strain.Acknowledgements
No acknowledgement found.References
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