Myocardial Synchronized Exercise and Prognosis in Patients with Heart Failure with Preserved Ejection Fraction Assessed by Two-dimensional Ultrasound Speckle Tracking Stratified Strain Imaging

To evaluate myocardial synchronized exercise and clinical prognosis in patients with heart failure preserved ejection fraction (HFpEF), we utilized two-dimensional speckle tracking (2D-STI) stratified strain imaging. We retrospectively summarized 146 patients diagnosed with HFpEF in our hospital from January 2022 to January 2023. 2D-STI combined with stratified strain imaging was used to measure the overall left ventricular global longitudinal strain (LVGLS), the sub-endocardium, mid-myocardium, sub-epicardium LS of the left ventricle, as well as the basal, intermediate, and apical LS, the peak strain dispersion (PSD) and the transmural pressure difference, the postsystolic shortening (PSS), and early systolic lengthening. They were categorized into adverse and better prognosis groups based on major adverse cardiac events (MACE). MACE occurred in a total of 25 of 146 patients (17.12%). Compared with the better group (P < .05), there were significant differences in ages, incidences of myocardial infarction, pre-admission plasma brain natriuretic peptide levels, LVGLS, sub-endocardium and sub-epicardium LS, PSD, and PSS values in the adverse group. Compared to pretreatment in the better group at 1-month follow-up, LVGLS, sub-endocardium, mid-level, sub-epicardium LS, PSD, and PSS values improved significantly (P < .05), but the adverse group did not (P > .05). Multivariate Cox regression demonstrated that pretreatment LVGLS (HR = 1.362, 95% CI = 1.026-1.809, P = .033), sub-epicardium LS (HR = 1.669, 95% CI = 1.068-2.609, P = .025), and PSD values (HR = 1.075, 95% CI = 1.014-1.140, P = .015) were important predictors of the occurrence of MACE in patients with HFpEF. The receiver operating curves manifested that the area under the curve of pretreatment LVGLS, sub-epicardium LS, and PSD values for predicting the occurrence of MACE were 0.812 (95% CI = 0.730-0.894, P < .001), 0.847 (95% CI = 0.775-0.919, P < .001), and 0.924 (95% CI = 0.863-0.984, P < .001). 2D-STI combined with stratified strain imaging can provide a more comprehensive, objective, and accurate assessment of myocardial synchronized exercise and clinical prognosis in patients with HFpEF, and LVGLS, sub-epicardium LS, and PSD values can be used in clinical practice as noninvasive, sensitive indicators for predicting the occurrence of MACE.