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The prognostic value of myocardial deformational patterns on all-cause mortality is modified by ischemic cardiomyopathy in patients with heart failure

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Abstract

Early systolic lengthening and postsystolic shortening may yield prognostic information in cardiovascular high-risk groups. We aimed to investigate the prognostic potential of these patterns in patients with heart failure with reduced ejection fraction (HFrEF), and specifically if the value was greater in patients with ischemic etiology. A total of 884 patients with HFrEF (66 ± 12 years, male 73%, mean EF 28 ± 9%) underwent speckle tracking echocardiography. Of these, 61% suffered from ischemic cardiomyopathy (ICM). Patients were followed for all-cause mortality. We assessed myocardial lengthening during early systole, defined by the early systolic strain index (ESI): [-100x (peak positive strain/maximal strain)] and myocardial shortening after aortic valve closure, defined by the postsystolic strain index (PSI): [100x (postsystolic strain—peak systolic strain)/maximal strain]. During median follow-up of 3.4 [interquartile range 1.9 to 4.8] years, 132 patients (15%) died. ICM modified the relationship between ESI and all-cause mortality (P interaction = 0.008), but not for PSI (P interaction = 0.13). When assessing patients with ICM by Cox proportional hazards models, per 1% increase in ESI (HR 1.09 [1.04 to 1.15], P < 0.001) and PSI (HR 1.02 [1.01 to 1.03], P = 0.002) were associated with all-cause mortality. However, in multivariable models adjusted for clinical, invasive and echocardiographic information, only ESI was a predictor of the endpoint (HR 1.07 [1.00 to 1.13], P = 0.023). In patients with no ICM, neither ESI (HR 0.99 per 1% increase [0.90 to 1.09], P = 0.86) nor PSI (HR 1.00 per 1% increase [0.99 to 1.02], P = 0.88) were associated with all-cause mortality. Our results indicate that in HFrEF patients with ischemic etiology, the ESI may provide some information on prognosis, whereas the prognostic value of PSI is reduced. In patients with HFrEF and no prior exposure to ischemia, the prognostic value of both deformational patterns is reduced.

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Because of the sensitive nature of the data collected for this study, the data will not be made publicly available.

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Acknowledgements

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Funding

PB received funding from the Independent Research Fund Denmark (Grant no.: 0129-00003B). The funding source had no involvement in the design, conduct or writing of this manuscript.

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Author notes

  1. Philip Brainin and Anna Engell Holm contributed equally.

Authors and Affiliations

  1. Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark

    Philip Brainin, Anna Engell Holm, Morten Sengeløv, Peter Godsk Jørgensen, Morten Schou, Sune Pedersen, Thomas Fritz-Hansen & Tor Biering-Sørensen

  2. Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil

    Philip Brainin & Anna Engell Holm

  3. Department of Cardiology, Zealand University Hospital, Roskilde, Denmark

    Niels Eske Bruun

  4. Clinical Institutes, Copenhagen and Aalborg Universities, Copenhagen, Denmark

    Niels Eske Bruun

  5. Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark

    Tor Biering-Sørensen

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  1. Philip Brainin
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Contributions

PB and AEH (Conception of hypothesis, data analysis, writing of manuscript), MS (data analysis, critical revision), PGJ (critical revision), NEB (critical revision), MS (critical revision), SP (critical revision), TF-H (critical revision), TB-S (critical revision).

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Correspondence to Philip Brainin.

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Conflict of interest

PGJ has received lecture fees from Novo Nordisk and Astra Zeneca. PB, AEH, MS, NEB, MS, SP, TFH and TBS report no conflicts of interest.

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The study was approved by the local Ethics Committee and Institutional Review Board and therefore conforms to all principles outlined in the 2nd Declaration of Helsinki.

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Brainin, P., Holm, A.E., Sengeløv, M. et al. The prognostic value of myocardial deformational patterns on all-cause mortality is modified by ischemic cardiomyopathy in patients with heart failure. Int J Cardiovasc Imaging 37, 3137–3144 (2021). https://doi.org/10.1007/s10554-021-02291-3

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