Global constructive myocardial work predicts reduction of ejection fraction in patients with heart failure with preserved ejection fraction

Abstract Background Despite advances in treatment of heart failure with preserved ejection fraction (HFpEF) its management remains challenging. SGLT2 inhibitors benefits across the full range fraction, and sacubitril/valsartan up to lower end EF <57% implies that some patients HFpEF pathophysiological mechanisms HFrEF might co-exist, subset benefit from proven HFrEF, particularly those deterioration over time. We aimed found out predictors assuming we can start treating them earlier therapies preventing further deterioration. Methods studied 215 (63% women) 73±8 years HFpEF. All had records comorbidity Charlson index (CI), glomerular filtration rate (GFR). Echocardiography (EchoCG) was performed offline analysis, including calculations myocardial work (MW), global longitudinal (LS), radial (RS), circumferential (SS) area strain (AS) by one experienced specialist. GW obtained pressure-strain loops derived speckle tracking analysis multiplied brachial systolic blood pressure. Global constructive (GCW) as sum positive due shortening during systole negative lengthening isovolumic relaxation, wasted energy loss efficiency percentage ratio were obtained. RS, SS AS calculated 3D dedicated software. Patients followed for 3 years. Results 5 developed infarction excluded study. Baseline higher women (61,2±3,1 vs 56,4±2,7; P<0.002), >70 (62,4±2,1 57,1±2,3; p<0.005), end-diastolic volume <60 ml/m2 (56,1±3,2 63,4±2,3; p<0.001). Overall decline compare baseline −7.3±1.6%, p<0.01. Reduction more prominent (−6,9±1,8 −5,7±1,7; P<0,002), coronary artery disease (CAD) (−7,2±1,9 −5,8±1,6; P<0,001) did not relate sex, LV size, CI, GFR. During follow 58 (27%) <50%. observed significant worsening (−27.9±8.5% −24.7±5.3%, p<0.003), LS (−19.7±2.4% −17.1±1.6%, GCW (GCW 2378±117 2107±102 mmHg%, p<0.002). <50% at study significantly less values compared EF>50% (22.4±7.2% −27.6±8.1%, p<0.002; 2081±92 2489±127 predictor (area under curve 0,875). Conclusion predicts reduction which may help identify who prevent upcoming Funding Acknowledgement Type funding sources: None.