Myocardial contractile dysfunction associated with increased 3-month and 1-year mortality in hospitalized patients with heart failure and preserved ejection fraction

• Published in: International journal of cardiology Vol. 168; no. 3; pp. 1975 - 1983
• Main Authors: Zhong, Liang, Ng, Kenneth K.C., Sim, Ling Ling, Allen, John Carson, Lau, Yee How, Sim, David K.L., Lee, Raymond K.K., Poh, Kian Keong, Chua, Terrance S.J., Kassab, Ghassan S., Kwok, Bernard W.K., Tan, Ru San
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier B.V 03.10.2013; Elsevier Ireland Ltd; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Contractility; Disease Progression; Echocardiography; Echocardiography, Doppler; Female; Follow-Up Studies; Heart; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospital Mortality - trends; Humans; Inpatients; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Myocardial Contraction - physiology; Normalized wall-stress; Pathophysiology; Prognosis; Prospective Studies; Singapore - epidemiology; Stroke Volume - physiology; Survival Rate - trends; Time Factors; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Heart failure; Prognosis; Normalized wall-stress; Pathophysiology; Contractility; Human; Cardiac performance; Wall; Pathogenesis; Mortality; Patient; Cardiovascular disease; Hospitalization; Epidemiology; Stress; Association; Heart disease; Hemodynamics; Cardiology; Ejection fraction
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2012.12.084

There is a clinical need for a contractility index that reflects myocardial contractile dysfunction even when ejection fraction (EF) is preserved. We used novel relative load-independent global and regional contractility indices to compare left ventricular (LV) contractile function in three groups: heart failure (HF) with preserved ejection fraction (HFPEF), HF with reduced ejection fraction (HFREF) and normal subjects. Also, we determined the associations of these parameters with 3-month and 1-year mortality in HFPEF patients. 199 HFPEF patients [median age (IQR): 75 (67–80) years] and 327 HFREF patients [69 (59–76) years] were recruited following hospitalization for HF; 22 normal control subjects [65 (54–71) years] were recruited for comparison. All patients underwent standard two-dimensional Doppler and tissue Doppler echocardiography to characterize LV dimension, structure, global and regional contractile function. The median (IQR) global LV contractility index, dσ*/dtmax was 4.30s−1 (3.51–4.57s−1) in normal subjects but reduced in HFPEF [2.57 (2.08–3.64)] and HFREF patients [1.77 (1.34–2.30)]. Similarly, median (IQR) regional LV contractility index was 99% (88–104%) in normal subjects and reduced in HFPEF [81% (66–96%)] and HFREF [56% (41–71%)] patients. Multi-variable logistic regression analysis on HFPEF identified sc-mFS <76% as the most consistent predictor of both 3-month (OR=7.15, p<0.05) and 1-year (OR=2.57, p<0.05) mortality after adjusting for medical conditions and other echocardiographic measurements. Patients with HFPEF exhibited decreased LV global and regional contractility. This population-based study demonstrated that depressed regional contractility index was associated with higher 3-month and 1-year mortality in HFPEF patients.