Heart failure
GLS in
HFrEF — prognostic marker (>-10% cut-off)
HFmrEF — prognosis & diagnosis
HFpEF — prognosis & diagnosis
GLS in „high-risk“ patients as a prognostic marker
LV-function in normal EF reduced (cut-off -16% in HFpEF)
GLS as a morphological parameter of HF
HFmrEF with apical dyskinesia & aneurysm formation with a severely reduced GLS, EF
Addendum Diabetes: The GLS in the lower normal range in patients with DM & suboptimally controlled blood sugar is significantly worse compared to healthy individuals (-18,62%). The Dispersion is prolonged in all patients with DMII — cut-off of 50ms as marker of myocardial damage in DMII ➜ early „coordination problem“ of the LV segments in normal EF & borderline Strain thus resulting in subclinical DD (increase in myocardial wall thickening, remodeling & rigidity of the LV, compliance decreases)
LASr + FWS/sPAP as a marker for functioning compensation mechanisms in HFrEF patients (LASr <15%; FWS/sPAP ≤ -0,5) — in LASr <15% & FWS/sPAP >-0,5 = worse prognosis
– LASr <15% as a marker of LA damage & und fibrosis in HFrEF
– LASr <23% as predictor for a reduced VO2max (<14ml/kg/min)
LASr <23% ➜ diastolic dysfunction in normal EF, double hospitalisations & 1 NYHA class higher
Patient with diabetes, normal EF, borderline strain & prolonged dispersion
HFrEF with a severely reduced LASr
HFmrEF with significantly reduced LA Strain
Mandoli et al, ESC Heart Fail. 2022/Maffeis et al., 2022/Morries, JACC Cardiovasc Imaging 2018/Park et al., J Am Heart Assoc. 2021/Freed et al., Circ Cardiovasc Imaging 2016/Park et al., European Heart Journal - Cardiovascular Imaging 2021/Pieske B. Eur Heart J 2019;40:3297/Kraigher-Kariner E. JACC 2014;63:447; li et al, Scientific reports, 2020
RV Strain, LA Strain & HFrEF
FWS of the RV as outcome predictor in HFrEF >-15% as cut-off
LASr with a cut-off of 14,5% as a marker for stroke in decompensated heart failure in SR (independent of EF) ➜ double the incidence
Absolute decrease of 1% of the LASr leads to an increase of stroke risk by 3,8%
1% improvement of the LASr in acute HF, independent of EF, leads to a risk reduction of complications
LASr <16,5% is associated with a worse prognosis in acute HF in the follow-up over 60 months. LASr <8,8% has the worst prognosis
LASr using a cut-off of 12-25% as a prognostic marker (HFpEF & HFmrEF have higher values than HFrEF)
GLS reduction in HF leads to LASr reduction, rarely good GLS, worse LASr; LASr correlates with HF
Staging (Stage A LASr 33%, B LASr 24%, C LASr 18%)
