Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy
Abstract Background Heart failure with preserved ejection fraction (HFpEF) represents a significant proportion of heart failure cases. Accurate diagnosis is challenging due to the heterogeneous nature of the disease and limitations in traditional echocardiographic parameters. Main body This review a...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-03-01
|
| Series: | Cardiovascular Ultrasound |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12947-024-00323-1 |
| _version_ | 1827328473389072384 |
|---|---|
| author | Mariane Higa Shinzato Natasha Santos Gustavo Nishida Henrique Moriya Jorge Assef Fausto Feres Renato A. Hortegal |
| author_facet | Mariane Higa Shinzato Natasha Santos Gustavo Nishida Henrique Moriya Jorge Assef Fausto Feres Renato A. Hortegal |
| author_sort | Mariane Higa Shinzato |
| collection | DOAJ |
| description | Abstract Background Heart failure with preserved ejection fraction (HFpEF) represents a significant proportion of heart failure cases. Accurate diagnosis is challenging due to the heterogeneous nature of the disease and limitations in traditional echocardiographic parameters. Main body This review appraises the application of Global Longitudinal Strain (GLS) and Left Atrial Strain (LAS) as echocardiographic biomarkers in the diagnosis and phenotyping of HFpEF. Strain imaging, particularly Speckle Tracking Echocardiography, offers a superior assessment of myocardial deformation, providing a more detailed insight into left heart function than traditional metrics. Normal ranges for GLS and LAS are considered, acknowledging the impact of demographic and technical factors on these values. Clinical studies have demonstrated the prognostic value of GLS and LAS in HFpEF, especially in predicting cardiovascular outcomes and distinguishing HFpEF from other causes of dyspnea. Nevertheless, the variability of strain measurements and the potential for false-negative results underline the need for careful clinical interpretation. The HFA-PEFF scoring system's integration of these biomarkers, although systematic, reveals gaps in addressing the full spectrum of HFpEF pathology. The combined use of GLS and LAS has been suggested to define HFpEF phenogroups, which could lead to more personalized treatment plans. Conclusion GLS and LAS have emerged as pivotal tools in the non-invasive diagnosis and stratification of HFpEF, offering a promise for tailored therapeutic strategies. Despite their potential, a structured approach to incorporating these biomarkers into standard diagnostic workflows is essential. Future clinical guidelines should include clear directives for the combined utilization of GLS and LAS, accentuating their role in the multidimensional assessment of HFpEF. |
| first_indexed | 2024-03-07T15:18:25Z |
| format | Article |
| id | doaj.art-c735a09f8d0c4878a8d53c41ffdfa6c1 |
| institution | Directory Open Access Journal |
| issn | 1476-7120 |
| language | English |
| last_indexed | 2024-03-07T15:18:25Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Ultrasound |
| spelling | doaj.art-c735a09f8d0c4878a8d53c41ffdfa6c12024-03-05T17:50:09ZengBMCCardiovascular Ultrasound1476-71202024-03-012211910.1186/s12947-024-00323-1Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategyMariane Higa Shinzato0Natasha Santos1Gustavo Nishida2Henrique Moriya3Jorge Assef4Fausto Feres5Renato A. Hortegal6Dante Pazzanese Institute of CardiologyDante Pazzanese Institute of CardiologyDante Pazzanese Institute of CardiologyDante Pazzanese Institute of CardiologyDante Pazzanese Institute of CardiologyDante Pazzanese Institute of CardiologyDante Pazzanese Institute of CardiologyAbstract Background Heart failure with preserved ejection fraction (HFpEF) represents a significant proportion of heart failure cases. Accurate diagnosis is challenging due to the heterogeneous nature of the disease and limitations in traditional echocardiographic parameters. Main body This review appraises the application of Global Longitudinal Strain (GLS) and Left Atrial Strain (LAS) as echocardiographic biomarkers in the diagnosis and phenotyping of HFpEF. Strain imaging, particularly Speckle Tracking Echocardiography, offers a superior assessment of myocardial deformation, providing a more detailed insight into left heart function than traditional metrics. Normal ranges for GLS and LAS are considered, acknowledging the impact of demographic and technical factors on these values. Clinical studies have demonstrated the prognostic value of GLS and LAS in HFpEF, especially in predicting cardiovascular outcomes and distinguishing HFpEF from other causes of dyspnea. Nevertheless, the variability of strain measurements and the potential for false-negative results underline the need for careful clinical interpretation. The HFA-PEFF scoring system's integration of these biomarkers, although systematic, reveals gaps in addressing the full spectrum of HFpEF pathology. The combined use of GLS and LAS has been suggested to define HFpEF phenogroups, which could lead to more personalized treatment plans. Conclusion GLS and LAS have emerged as pivotal tools in the non-invasive diagnosis and stratification of HFpEF, offering a promise for tailored therapeutic strategies. Despite their potential, a structured approach to incorporating these biomarkers into standard diagnostic workflows is essential. Future clinical guidelines should include clear directives for the combined utilization of GLS and LAS, accentuating their role in the multidimensional assessment of HFpEF.https://doi.org/10.1186/s12947-024-00323-1Heart failure with preserved ejection fractionSpeckle-tracking echocardiographyLeft ventricular strainLeft atrial strainPrecision medicine |
| spellingShingle | Mariane Higa Shinzato Natasha Santos Gustavo Nishida Henrique Moriya Jorge Assef Fausto Feres Renato A. Hortegal Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy Cardiovascular Ultrasound Heart failure with preserved ejection fraction Speckle-tracking echocardiography Left ventricular strain Left atrial strain Precision medicine |
| title | Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy |
| title_full | Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy |
| title_fullStr | Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy |
| title_full_unstemmed | Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy |
| title_short | Left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction: the evidence so far and prospects for phenotyping strategy |
| title_sort | left ventricular and atrial myocardial strain in heart failure with preserved ejection fraction the evidence so far and prospects for phenotyping strategy |
| topic | Heart failure with preserved ejection fraction Speckle-tracking echocardiography Left ventricular strain Left atrial strain Precision medicine |
| url | https://doi.org/10.1186/s12947-024-00323-1 |
| work_keys_str_mv | AT marianehigashinzato leftventricularandatrialmyocardialstraininheartfailurewithpreservedejectionfractiontheevidencesofarandprospectsforphenotypingstrategy AT natashasantos leftventricularandatrialmyocardialstraininheartfailurewithpreservedejectionfractiontheevidencesofarandprospectsforphenotypingstrategy AT gustavonishida leftventricularandatrialmyocardialstraininheartfailurewithpreservedejectionfractiontheevidencesofarandprospectsforphenotypingstrategy AT henriquemoriya leftventricularandatrialmyocardialstraininheartfailurewithpreservedejectionfractiontheevidencesofarandprospectsforphenotypingstrategy AT jorgeassef leftventricularandatrialmyocardialstraininheartfailurewithpreservedejectionfractiontheevidencesofarandprospectsforphenotypingstrategy AT faustoferes leftventricularandatrialmyocardialstraininheartfailurewithpreservedejectionfractiontheevidencesofarandprospectsforphenotypingstrategy AT renatoahortegal leftventricularandatrialmyocardialstraininheartfailurewithpreservedejectionfractiontheevidencesofarandprospectsforphenotypingstrategy |