Incremental Prognostic Value of Multi-chamber Deformation Imaging to Predict Adverse Outcome in Heart Failure With Reduced Ejection Fraction

Introduction: Left ventricular (LV) deformation imaging is used for management of heart failure with reduced LV ejection fraction (EF) ie. HFrEF. However, the incremental value of multichamber deformation imaging is unclear. Methods: Forty-nine subjects (72±13 yrs; 28M) with HFrEF underwent computation of LV-global longitudinal strain (LV-GLS%), right ventricular strain (RV-S%, estimated as an average of basal, mid and apical strain), and LA reservoir strain (LA-RS%) occurring during LV systole. Standard echo variables included LVEF, chamber dimensions, E/E′ ratio as a surrogate of LV filling pressure, and pulmonary artery systolic pressure (PASP). Results: Mean±SD of LVEF, LV-GLS% and RV-S% were 31±3%, 7±3%, and 17±7%, respectively. Over a 4.2 yr follow-up period, 24% of patients died and 48% had a composite outcome of death and HF hospitalization. Kaplan Meier survival analysis showed no difference in survival between men u0026 women with HFrEF (p=0.70). In the logistic regression model (R 2 =0.68, P=0.0002 and ROC area =0.92), taking composite of death and HF hospitalization as a dichotomous variable, RV-S%, E/E′ ratio, and PASP were the only significant univariate predictors of adverse outcome (all p 88 mg/dl and a cutoff value of LA-RS% Conclusions: Multi-chamber deformation imaging along with renal function status could best predict adverse outcome in HFrEF that appear to be superior to conventional echo parameters.