Multimodality imaging approach by speckle tracking echocardiography and cardiac magnetic resonance of heart failure with preserved ejection fraction, a step forward

Roxana Rimbas, Diana Mihalcea, Alexandra Maria Chitroceanu, Simona Visoiu, Sorina Mihaila-Baldea, Lucia-Stefania Magda, Maria-Luiza Luchian, Andrei-Victor Marinescu, Alina Necula, Dragos Vinereanu

Research output: Unpublished contribution to conferencePoster


Background. Heart failure with preserved ejection fraction (HFpEF), defined by 2016 guidelines and new 2019 scoring system, isone 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 speckle­tracking 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, andcompared them with 25 normal, age­matched, 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 by2DSTE: 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 meanextracellular volume (ECVm), and pre­gadolinium 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 HFpEFpatients. GCW did not change, whereas GWW increased and GWE decreased significantly in HFpEF patients (Table). NTproBNPcorrelated 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 corelatedsignificantly with sPAP, E/E’ ratio and E’m, LVEFcmr and LVmass, preGDT1m, and ECVm (all r>0.4, p<0.05). GWW was bestpredicted 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 dysfunctionparameters, LV mass, LVEF, and most important with myocardial fibrosis markers evaluated by CMR. ECVm by CMR was theonly independent predictor of NTproBNP. Therefore, new parameters of myocardial work, derived from 2DSTE, might provide abetter understanding of HFpEF
Original languageEnglish
Publication statusPublished - 8 Feb 2021
EventEACVI - Best of Imaging 2020 - Online event
Duration: 11 Dec 202012 Dec 2020


ConferenceEACVI - Best of Imaging 2020


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