Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3‐Chamber Strain Echocardiography

Background Heart failure (HF) involves dysfunction of the left ventricle (LV) as well as left atrium and right ventricle. We characterized mechanical phenotypes of HF using 3‐chamber strain echocardiography and compared their clinical outcomes. Methods and Results We retrospectively analyzed 3574 pa...

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Main Authors: Jiesuck Park, Hong‐Mi Choi, In‐Chang Hwang, Yeonyee E. Yoon, Jun‐Bean Park, Jae‐Hyeong Park, Goo‐Yeong Cho
Format: Article
Language:English
Published: Wiley 2022-12-01
Series:Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Subjects:
Online Access:https://www.ahajournals.org/doi/10.1161/JAHA.122.028040
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author Jiesuck Park
Hong‐Mi Choi
In‐Chang Hwang
Yeonyee E. Yoon
Jun‐Bean Park
Jae‐Hyeong Park
Goo‐Yeong Cho
author_facet Jiesuck Park
Hong‐Mi Choi
In‐Chang Hwang
Yeonyee E. Yoon
Jun‐Bean Park
Jae‐Hyeong Park
Goo‐Yeong Cho
author_sort Jiesuck Park
collection DOAJ
description Background Heart failure (HF) involves dysfunction of the left ventricle (LV) as well as left atrium and right ventricle. We characterized mechanical phenotypes of HF using 3‐chamber strain echocardiography and compared their clinical outcomes. Methods and Results We retrospectively analyzed 3574 patients (median age, 74 years; male 52.8%) with acute HF who underwent 3‐chamber strain echocardiography. Patients were classified as with LV, left atrium, or right ventricle myopathy if their corresponding strain values (LV global longitudinal strain, left atrium reservoir strain, and right ventricle global longitudinal strain) were lower than median cutoffs, respectively. The mechanical phenotypes of individual patients were characterized according to the combined myopathy. The primary outcome was a composite end point of 5‐year all‐cause mortality and HF hospitalization. During follow‐up (median, 25.8 months), the primary outcome occurred in 1877 (52.5%) patients. Three‐chamber strain values were independent predictors for the primary outcome. An incremental trend was observed for the primary outcome, along with the increasing numbers of combined myopathy. Each mechanical phenotype exhibited an increased risk of the primary outcome, with the highest risk observed in patients with 3‐chamber myopathy (hazard ratio, 1.67 [95% CI, 1.42–1.96]). The prognostic significance of the mechanical phenotypes was feasible across the conventional HF subtypes stratified by LV ejection fraction. In HF with preserved ejection fraction, the presence of left atrium and right ventricle myopathy significantly increased the primary outcome, regardless of combined left ventricle myopathy. Conclusions Assessment of 3‐chamber strain in HF enables characterization of distinctive mechanical phenotypes, which provides an independent prognostic value that may support long‐term risk stratification.
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spelling doaj.art-33497fd50e564c88a259ff2c929ab0402023-02-07T16:03:22ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-12-01112310.1161/JAHA.122.028040Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3‐Chamber Strain EchocardiographyJiesuck Park0Hong‐Mi Choi1In‐Chang Hwang2Yeonyee E. Yoon3Jun‐Bean Park4Jae‐Hyeong Park5Goo‐Yeong Cho6Department of Cardiology, Cardiovascular Center Seoul National University Bundang Hospital Seongnam Gyeonggi‐do Republic of KoreaDepartment of Cardiology, Cardiovascular Center Seoul National University Bundang Hospital Seongnam Gyeonggi‐do Republic of KoreaDepartment of Cardiology, Cardiovascular Center Seoul National University Bundang Hospital Seongnam Gyeonggi‐do Republic of KoreaDepartment of Cardiology, Cardiovascular Center Seoul National University Bundang Hospital Seongnam Gyeonggi‐do Republic of KoreaDepartment of Internal Medicine Seoul National University College of Medicine Seoul Republic of KoreaDepartment of Cardiology, Internal Medicine Chungnam National University Hospital Daejeon Republic of KoreaDepartment of Cardiology, Cardiovascular Center Seoul National University Bundang Hospital Seongnam Gyeonggi‐do Republic of KoreaBackground Heart failure (HF) involves dysfunction of the left ventricle (LV) as well as left atrium and right ventricle. We characterized mechanical phenotypes of HF using 3‐chamber strain echocardiography and compared their clinical outcomes. Methods and Results We retrospectively analyzed 3574 patients (median age, 74 years; male 52.8%) with acute HF who underwent 3‐chamber strain echocardiography. Patients were classified as with LV, left atrium, or right ventricle myopathy if their corresponding strain values (LV global longitudinal strain, left atrium reservoir strain, and right ventricle global longitudinal strain) were lower than median cutoffs, respectively. The mechanical phenotypes of individual patients were characterized according to the combined myopathy. The primary outcome was a composite end point of 5‐year all‐cause mortality and HF hospitalization. During follow‐up (median, 25.8 months), the primary outcome occurred in 1877 (52.5%) patients. Three‐chamber strain values were independent predictors for the primary outcome. An incremental trend was observed for the primary outcome, along with the increasing numbers of combined myopathy. Each mechanical phenotype exhibited an increased risk of the primary outcome, with the highest risk observed in patients with 3‐chamber myopathy (hazard ratio, 1.67 [95% CI, 1.42–1.96]). The prognostic significance of the mechanical phenotypes was feasible across the conventional HF subtypes stratified by LV ejection fraction. In HF with preserved ejection fraction, the presence of left atrium and right ventricle myopathy significantly increased the primary outcome, regardless of combined left ventricle myopathy. Conclusions Assessment of 3‐chamber strain in HF enables characterization of distinctive mechanical phenotypes, which provides an independent prognostic value that may support long‐term risk stratification.https://www.ahajournals.org/doi/10.1161/JAHA.122.028040echocardiographyheart failuremyopathystrain
spellingShingle Jiesuck Park
Hong‐Mi Choi
In‐Chang Hwang
Yeonyee E. Yoon
Jun‐Bean Park
Jae‐Hyeong Park
Goo‐Yeong Cho
Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3‐Chamber Strain Echocardiography
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
echocardiography
heart failure
myopathy
strain
title Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3‐Chamber Strain Echocardiography
title_full Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3‐Chamber Strain Echocardiography
title_fullStr Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3‐Chamber Strain Echocardiography
title_full_unstemmed Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3‐Chamber Strain Echocardiography
title_short Prognostic Implications of Mechanical Phenotypes in Heart Failure Characterized by 3‐Chamber Strain Echocardiography
title_sort prognostic implications of mechanical phenotypes in heart failure characterized by 3 chamber strain echocardiography
topic echocardiography
heart failure
myopathy
strain
url https://www.ahajournals.org/doi/10.1161/JAHA.122.028040
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