Abstract Body (Do not enter title and authors here): Background: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome caused by various pathophysiologic mechanisms, and has recently received increasing attention. Many research results show that the longitudinal left ventricular (LV) function is deteriorated, however, in the real world, we often encounter patients with preserved LV global longitudinal strain (GLS). This study sought to determine the prevalence, characteristics, and outcome of patients with preserved LV GLS in a real-world registry of HFpEF.
Method: The registry data included 1,798 patients with HFpEF (72.2 ± 11.6 years, 55.2% female) who met the inclusion criteria of previous randomized controlled trials (New York Heart Association class II or higher symptoms, LVEF > 40%, and NT-proBNP > 300 pg/mL) at a single tertiary hospital between 2014 and 2021. LV GLS analysis was performed using vendor-independent 2D speckle-tracking imaging software (TomTec; Image Arena 4.6, Munich, Germany). Patients with LV GLS ≤ -18% were defined as heart failure with preserved GLS. The primary outcome was a composite of heart failure admissions and cardiovascular death.
Results: In this population, 757 (42.1%) patients had preserved LV GLS. The patients with preserved GLS were tended to be younger (71.7 ± 11.5 vs. 72.7 ± 11.6 years, p=0.073) and more female predominance (60.6 vs. 51.3%, p<0.001), and wider pulse pressure (61.0 ± 17.4 vs. 54.8 ± 18.1 mmHg, p<0.001) compared with those with reduced GLS. The average NT-pro BNP of the preserved GLS group was 2242.4 ± 4391.8 pg/ml and the average LV GLS was -20.1±1.6%, which were significantly lower than each value of the reduced GLS group. In terms of echocardiographic characteristics, the patients with preserved GLS had higher LV ejection fraction (68.8 ± 5.8 vs. 62.5 ± 8.6%, p<0.001) and stroke volume (78.1 ± 21.4 vs. 61.9 ± 19.3, p<0.001). During 21.3 months (interquartile range 6.6-39.7 months) follow-up, the group with preserved GLS had a better primary outcome than the group with reduced GLS (log-rank p < 0.001) (Figure)
Conclusion: Heart failure with preserved GLS is common among patients with HFpEF in real-world data. This phenotype is more common in females, is associated with higher stroke volume and arterial stiffness, and ultimately shows a favorable outcome.