Special Issue: Noninvasive Assessment of Left Ventricular Diastolic Function
State-of-the-Art Review
Myocardial Mechanics in Patients With Normal LVEF and Diastolic Dysfunction

https://doi.org/10.1016/j.jcmg.2018.12.035Get rights and content
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Highlights

  • HFpEF is a complex clinical entity that is poorly understood yet is present in up to 5.5% of the general population.

  • Assessment of myocardial mechanics provides unique insight into the pattern of the myocardial dysfunction observed during disease progression through preclinical and clinical HFpEF.

  • Novel phenotyping methods, including machine learning, can integrate these myocardial mechanics into clinical groups used to advise and treat patients.

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical entity that is poorly understood yet present in up to 5.5% of the general population. Proven therapies for this disorder are lacking, even though it has a similar prognosis to that of heart failure with reduced ejection fraction (HFrEF). Innovative imaging techniques have provided in-depth understanding of the unique pattern of left ventricular mechanics in patients with HFpEF who progress through preclinical (Stages A to B) and clinical (Stages C to D) American College of Cardiology/American Heart Association heart failure stages. This review highlights the mechanical basis of this disorder from the cellular and myofiber level to chamber dysfunction. As each chamber of the heart is examined, specific biomarkers and echocardiographic parameters with diagnostic and prognostic values are discussed. Finally, novel phenotyping methods including machine learning are reviewed that integrate these mechanics into clinical groups to advise and treat patients.

Key Words

deformation imaging
diastolic dysfunction
global longitudinal strain
heart failure with preserved ejection fraction
left atrial strain
left ventricular strain
myocardial strain
right ventricular strain

Abbreviations and Acronyms

GCS
global circumferential strain
GLS
global longitudinal strain
GRS
global radial strain
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
LAScd
left atrium strain during conduit phase
LASct
left atrium strain during contractile phase
LASr
left atrium strain during reservoir phase
PH
pulmonary hypertension
RVLS
right ventricle longitudinal strain

Cited by (0)

Dr. Bianco is a private investigator for an AstraZeneca trial. Dr. Sengupta is an advisor to HeartSciences, Ultromics, and Hitachi Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sherif Nagueh, MD, served as Guest Editor for this paper.