Speckle-tracking echocardiography in assessing staged cardiac remodeling in ischemic heart failure
Abstract
Aim. To assess the features of global staged remodeling of the heart chambers in patients with ischemic chronic heart failure, depending on the degree of left ventricular ejection fraction (LVEF) reduction, using two-dimensional echocardiography with myocardial deformation analysis.
Materials and methods. The study included 96 patients with a confirmed diagnosis of CHF according to current criteria. Patients were divided into three groups based on LVEF: Group I – LVEF >50% (n=46, preserved systolic function); Group II – LVEF 40-49% (n=24, mildly reduced systolic function); Group III – LVEF <40% (n=26, significantly reduced systolic function). Global longitudinal strain (GLS) of the LV was significantly lower in patients with reduced ejection fraction.
Results. In the group with LVEF >50%, the mean GLS was 17.0 ± 2.8%, while in those with LVEF 40–49% and <40%, values decreased to 12.6 ± 2.1% and 9.4 ± 2.2%, respectively (p < 0.001). A similar trend was observed for GLS measured in 4-, 2-, and 3-chamber views. These findings indicate high sensitivity of GLS to impaired myocardial contractility and confirm its clinical significance in assessing LV functional status.The assessment of LA function using 2D speckle-tracking echocardiography in the reservoir, conduit, and contractile phases also revealed a significant decrease in absolute parameters: LASr (reservoir phase) - 35.5 ± 8.3% (LVEF >50%) →17.8 ± 11.2% (LVEF <40%), *p* < 0.001; LASct (conduit phase) - 17.6 ± 5.4% → 8.8 ± 6.5%, *p*< 0.001; LAScd (contractile phase) - 18.7 ± 5.9% → 8.7 ± 4.6%, *p* < 0.001. In patients with LVEF>50%, RV longitudinal strain parameters were highest (RVFWLS - 21.3 ± 4.0%; RV GLS - 18.1 ± 3.2%), while in LVEF 40–49%, they decreased (19.9 ± 2.8% and 16.0 ± 2.7%, respectively), and in LVEF <40%, the most pronounced decline was observed (RVFWLS: 14.0 ± 4.1%; RV GLS: 10.5 ± 3.1%), with significant intergroup differences (p=0.001).
Conclusion. Patients with ischemic CHF exhibit progressive remodeling of all heart chambers (LV, LA, and RV), with worsening functional impairment as LVEF declines. LV global longitudinal strain (GLS), as well as LA (LASr, LASct, LAScd) and RV (RVFWLS, RV GLS) deformation parameters, demonstrate high sensitivity to hemodynamic changes and may serve as early markers of CHF progression. Speckle-tracking echocardiography is an informative non-invasive method for assessing subclinical myocardial dysfunction and may be useful for risk stratification and therapy monitoring in patients with varying degrees of CHF severity.
About the Authors
List of references
Ponikowski P. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128.
Virani SS et al. Heart Disease and Stroke Statistics—2021 Update. Circulation. 2021;143:e254–e743. https://doi.org/10.1161/CIR.0000000000000950.
Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30–41. https://doi.org/10.1038/nrcardio.2010.165.
Thomas L., Muraru D., Popescu B.A., Sitges M., Rosca M., Pedrizzetti G., Henein M.Y., Donal E., Badano
L.P. Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice // J Am Soc Echocardiogr. – 2020. – Т. 33, № 8. – С. 934–952. https://doi.org/10.1016/j.echo.2020.03.021.
Yancy CW et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America J Am Coll Cardiol. 2017;70(6):776–803. https://doi.org/10.1161/CIR.0000000000000509.
Antonio Amador Calvilho Ju´nior. et al. Left Atrial Strain in the Analysis of LV Diastolic Function: Ready to Use? Arq Bras Cardiol: Imagem cardiovasc. 2023;36(1):e357. https://doi.org/10.36660/abcimg.2022357i.
Smiseth O.A. et al.. Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2022 Jan 24;23(2):e34-e61. https://doi.org/10.1093/ehjci/jeab154.
Gorter TM et al. Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur J Heart Fail. 2016;18(12):1472–1487. https://doi.org/10.1002/ejhf.630.
Stanton T et al. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circulation. 2009;119(17): 2613–2620. https://doi.org/10.1161/ CIRCIMAGING.109.862334.
Nagueh SF et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277–314. https://doi.org/10.1016/j.echo.2016.01.011
Copyright (c) 2025 Ф.М. Бекметова , Х.Г. Фозилов , Р.Ш. Бекбулатова , Ш.У. Хошимов , Ш.А. Оринбаев (Автор)
This work is licensed under a Creative Commons Attribution 4.0 International License.