Afterload increase challenge unmasks systolic abnormalities in heart failure with preserved ejection fraction

• Published in: International journal of cardiology Vol. 380; pp. 20 - 27
• Main Authors: Hortegal, Renato A., Valeri, Renata, Grizante, Mariana, Cancellier, Renato, Uemoto, Vinícius, Gun, Carlos, Assef, Jorge, Moriya, Henrique, Meneghelo, Romeu, Feres, Fausto, Franchini, Kleber G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.06.2023
• Subjects: Cardiac function; Echocardiography; Hand Strength; Heart Failure - diagnostic imaging; Heart failure with preserved ejection fraction; Heart Ventricles - diagnostic imaging; Humans; Speckle tracking echocardiography; Stroke Volume - physiology; Ventricular Function, Left - physiology; AFI; MRI; STE; LPSS; LVEF; LVESV; HR; LV; HFpEF; LAVI; BP; APLAX/4ch; GLS; GWE; 2ch; GWI; TDI; LVEDV; LAr; BMI; Heart failure with preserved ejection fraction; EKG; GWW; Speckle tracking echocardiography; RWT; MLHFQ; Cardiac function; GCW
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.03.042

Provocative maneuvers have the potential to overcome the low sensitivity of resting echocardiography and biomarkers in the detection of heart failure with preserved ejection fraction (HFpEF). We investigate the mechanical response of the left ventricle to an afterload challenge in patients with preclinical and early-stage HFpEF (es-HFpEF). Three groups of patients (non-HFpEF - n = 42, pre-HFpEF - n = 43, and es-HFpEF - n = 39) underwent echocardiography at rest and during an afterload challenge induced by handgrip maneuver combined with pneumatic constriction of limbs. Patients in the non-HF group displayed a median ΔLPSS = −4% (IQR: −10%, +2%), LPSS rest<16% in 3/42(7%) and LPSS stress<16% in 6/43(14%). Subjects in the pre-HFpEF group displayed median ΔLPSS = -3% (IQR: −10%, +5%) LPSS rest<16% in 13/43(30%) and LPSS stress<16% in 19/43 (44%). 11/43 (25%) subjects in this group increased at least one absolute point in LPSS during stress. Patients in es-HFpEF group displayed a median ΔLPSS = −10% (IQR: −18%, −1%), LPSS rest<16% in 15/39(38%) and LPSS stress<16% in 25/39(64%). Changes in LPSS (ΔLPSS) were significantly greater in es-HFpEF than pre-HFpEF (p = 0.022). In multivariate analysis, this group effect was maintained after adjustment of the LPSS for systolic blood pressure, use of β-blockers, LV mass, RWT, age, and sex. Our data suggest that patients with HFpEF have a marked decrease in peak strain during acute pressure overload. Longitudinal studies are needed to test and compare the clinical impact of each pattern in early and long-term follow-ups. •Afterload increase challenge is a provocative maneuver that potentially overcomes the low sensitivity of resting echocardiography and biomarkers in the detection heart failure with preserved ejection fraction (HFpEF)•We studied the mechanical response of the left ventricle to afterload challenge in a population of 124 subjects with different stages of HFpEF•Subjects with early-stage HFpEF display a marked decrease in peak strain during increased afterload