Introduction: There are no data regarding cardiac de-formation changes assessed layer by layer in the heart failure continuum from normal to diastolic dysfunc-tion (DD) and heart failure with preserved and mid-range ejection fraction (HFpEF/HFmEF), as defined by the 2016 ESC guidelines. We demonstrated previously, in a large group of normal subjects, that a transmural gradient exists for both left and right ventricle (LV/ RV), with higher values in the subendocardial layer, ir-respective of age and gender, and that LV dyssynchrony increases with age.
Methods: We assessed 105 subjects (65±10 years, 35-85, 55 males) by 2D convetional and speckle tracking echocardiography: 85 patients with DD (n=31), HFpEF (n=37), HFmEF (n=17), and 20 normal, age-matched subjects. We measured LVEF, LV E/E’ ratio, TAPSE, FAC, S’, and sPAP. We used a multi-layer approach by 2Dspeckle tracking to characterize longitudinal and circumferential ventricular deformation, as well as LV global longitudinal synchrony. LV and RV longitudinal deformation was assessed by longitudinal endo (LV/ RVendo), mid (LV/RVmid), and epicardial strain (LV/ RVepi). LV circumferential deformation was assessed similarly by endo (CSendo), mid (CSmid), and epicar-dial strain (CSepi). LV dyssynchrony index was defi-ned as standard deviation of all LV myocardial times to peak strain from each segment (SDTTPS).
Results: For each of LV layers longitudinal deformation decreased progressively, from normals to DD, HFpEF, and HFmEF (P<0.001): LVendo (-23±3 vs. -23±3 vs. -20±5 vs. -15±4), LVmid (-21±3 vs. -19±5 vs. -17±4 vs.-13±4), LVepi (-18±2 vs. -18±2 vs. -14±6 vs. -12±3). Meanwhile, there was a progressive increase of the LV dyssynchrony with HF severity. CSendo was similar between patients with HFpEF, DD, and normals, whe-reas CSmid and CSepi were increased, probably com-pensatory, but all of them decreased significantly in HFmEF: CSendo (-31±7 vs. -31±6 vs. -30±8 vs. -19±6), CSmid (-20±5 vs. -23±4 vs. -24±4 vs. -15±5), CSepi (-13±5 vs. -16±7 vs. -18±5 vs. -11±4). RV global systo-lic function was normal in all group, while sPAP in-creased only in HFmEF (p=0.018). RV longitudinal de-formation layer by layer decreased significantly only in HFmEF, whereas in patients with HFpEF and DD was preserved, similar to normal subjects: RVendo (-25±3 vs. -26±3 vs. -25±4 vs. -20±5), RVmid (-23±3 vs. -23±3 vs. -22±3 vs. -18±5), RVepi (-21±3 vs. -21±3 vs. -19±3 vs. -16±5). NTproBNP correlated significantly with all LV/RV myocardial layers deformation, SDTTPS, sPAP, and E/E’. However, the best predictor for NTproBNP level was E/E’ (r=0.73, p<0.001).
Conclusions: New multi-layer approach of ventricular myocardial deformation by speckle tracking provides better functional characterization of DD, HFpEF, and HFmEF patterns. Meanwhile, it suggests that HF is a continuum, progressing from diastolic dysfunction to different types of HF. Grant NR. 49 din 02/05/2018; Cod depunere: PN-III-P1-1.1-TE-2016-0669; HEART-PRESERVED.