Multimodality imaging approach by speckle tracking echocardiography and cardiac magnetic resonance of heart failure with preserved ejection fraction, a step forward. (8th February 2021)

• Record Type: Journal Article
• Authors: Rimbas, RC; Mihalcea, DJ; Chitroceanu, AM; Visoiu, SI; Mihaila-Baldea, S; Magda, LS; Luchian, ML; Marinescu, AV; Necula, AI; Vinereanu, D
• Is Part Of: European heart journal. Volume 22(2021)Supplement 1
• Publication Date: 2021-02-08
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa356.183
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project No. PN-III-P1-1-TE-2016-0669, within PNCDI III, and grant 5/2018 and 83/2018 Background. Heart failure with preserved ejection fraction (HFpEF), defined by 2016 guidelines and new 2019 scoring system, is one of the most challenging diagnosis in cardiology. A better understanding of this entity might provide us a better way to treat. Myocardial work (MW) by speckle-tracking echocardiography (STE) might be a promising tool for analysis of myocardial function. However, there is no data on MW changes in HFpEF patients. Methods. We assessed 94 patients (67 ± 9 yrs, 33 men) with HFpEF (NTproBNP of 349 ± 418 pg/ml), by 2D and STE, and compared them with 25 normal, age-matched, subjects; 80 patients had also a CMR evaluation. We measured LV ejection fraction (LVEF), mean E' (E'm), E/E', sPAP, left atrial volume indexed (LAVi), and global longitudinal stain (GLS). We assessed MW by 2DSTE: global constructive work (GCW), as the "positive" work of the heart; global wasted work (GWW), as the "negative work"; global work efficiency (GWE), as GCW/(GCW + GWW) in %. We evaluated by CMR LVEFcmr, LV mass, T1 mapping with mean extracellular volume (ECVm), and pre-gadolinium times quantification (preGDT1m) as markers of myocardial fibrosis. Results. Feasibility of the MW analysis was 97%. As expected, E/E' and sPAP were higher, while GLS was lower in HFpEF patients. GCW did not change, whereas GWW increased and GWE decreased significantly in HFpEF patients (Table). NTproBNP correlated with sPAP, LAVi, preGDT1m, and ECVm. ECVm was the only independent predictor of NTproBNP level (r = 0.40, p = 0.04). GWE corelated significantly with E'm, LVEFcmr, LV mass, and preGDT1m (all r > 0.40, p = 0.001). GWW corelated significantly with sPAP, E/E' ratio and E'm, LVEFcmr and LVmass, preGDT1m, and ECVm (all r > 0.4, p < 0.05). GWW was best predicted by a model composed by E"m, LVmass, preGDT1m (r = 0.5, r2 = 0.25, p = 0.003). Conclusion. MWE decreases, whereas WW increases in HFpEF. Both parameters corelates significantly with diastolic dysfunction parameters, LV mass, LVEF, and most important with myocardial fibrosis markers evaluated by CMR. ECVm by CMR was the only independent predictor of NTproBNP. Therefore, new parameters of myocardial work, derived from 2DSTE, might provide a better understanding of HFpEF.