Incremental prognostic value of multichamber deformation imaging and renal function status to predict adverse outcome in heart failure with reduced ejection fraction

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 35; no. 4; pp. 450 - 458
• Main Authors: Saha, Samir K., Luo, Xia‐Xia, Gopal, Aasha S., Govind, Satish C., Fang, Fang, Liu, Ming, Zhang, Qing, Ma, Chunyan, Dong, Ming, Kiotsekoglou, Anatoli, Yu, Cheuk‐Man
• Format: Journal Article
• Language: English
• Published: United States 01.04.2018
• Subjects: Aged; Echocardiography - methods; Female; four-chamber strain; Heart Atria - diagnostic imaging; Heart Atria - physiopathology; Heart Failure - diagnosis; Heart Failure - physiopathology; heart failure with reduced ejection fraction; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Kaplan-Meier Estimate; Kidney - physiopathology; Kidney Function Tests; left atrial strain; left ventricular strain; Male; Prognosis; right atrial strain; right ventricular strain; Risk Factors; Sensitivity and Specificity; Stroke Volume; four-chamber strain; left ventricular strain; right ventricular strain; heart failure with reduced ejection fraction; right atrial strain; left atrial strain
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/echo.13821

Aims Deformation imaging, particularly of left‐sided heart, is fast becoming an essential tool in clinical cardiology. However, data are scant regarding the value of biventricular and bi‐atrial deformation in association with comorbidities in heart failure with reduced left ventricular ejection fraction (HFREF). Methods and Results Forty‐nine subjects (72 ± 13 years; 28 male) with HFREF and 14 age‐matched controls underwent deformation imaging including LV global longitudinal strain (LVGLS%), right ventricular strain (RVS%), and left atrial reservoir strain (LARS%). Standard echo parameters included LVEF%, E/E′ ratio, and pulmonary artery systolic pressure (PASP). Mean ± SD of LVEF, LVGLS%, and RVS% were 31% ± 8%, 7% ± 3%, and 17% ± 7%, respectively, and were significantly lower compared with controls (all P < .0001). Over a follow‐up period of 4.2 years, 24% of patients died and 48% had a composite outcome of death and heart failure hospitalization. In the logistic regression model, taking the composite of death and heart failure hospitalization as a dichotomous variable, RVS%, E/E′ ratio, and PASP were the only significant univariate predictors of adverse outcome (R2 = .68, all P < .05). In the multivariate model, however, only PASP predicted adverse outcome. PASP also had the largest AUC (0.8) in the ROC analysis. A creatinine level of >88 μmol/L (SCREAT) and a cutoff value of LA reservoir strain (LARS %) at <16.7% provided the best sensitivity (86%) and specificity (40%) with an odds ratio of 3.8. In the Kaplan–Meier survival estimate, LARS%‐SCREAT predicted all‐cause mortality and HF hospitalization. Conclusion Multichamber deformation imaging along with renal function and PASP could best predict adverse outcome in HFREF.