Global Longitudinal Strain Predicts Poor Functional Capacity in Patients with Systolic Heart Failure

BACKGROUND: Left ventricular global longitudinal strain value (GLS) can predict functional capacity in patients with preserved left ventricular ejection fraction (LVEF) heart failure (HF) and to assess prognosis in reduced LVEF HF. OBJETIVE: Correlate GLS with parameters of Cardiopulmonary Exercise Test (CPET) and to assess if they could predict systolic HF patients that are more appropriated to be referred to heart transplantation according to CPET criteria. METHODS: Systolic HF patients with LVEF < 45%, NYHA functional class II and III, underwent prospectively CPET and echocardiography with strain analysis. LVEF and GLS were correlated with the following CPET variables: maxVO(2), VE/VCO(2) slope, heart rate reduction during the first minute of recovery (HRR) and time needed to reduce maxVO(2) in 50% after physical exercise (T(1/2)VO(2)). ROC curve analysis of GLS to predict VO(2) < 14 mL/kg/min and VE/VCO(2) slope > 35 (heart transplantation’s criteria) was performed. RESULTS: Twenty six patients were selected (age, 47 ± 12 years, 58% men, mean LVEF = 28 ± 8%). LVEF correlated only with maxVO(2) and T(1/2)VO(2). GLS correlated to all CPET variables (maxVO(2): r = 0.671, p = 0.001; VE/VCO(2) slope: r = -0.513, p = 0.007; HRR: r = 0.466, p = 0.016, and T(1/2)VO(2): r = -0.696, p = 0.001). GLS area under the ROC curve to predict heart transplantation’s criteria was 0.88 (sensitivity 75%, specificity 83%) for a cut-off value of -5.7%, p = 0.03. CONCLUSION: GLS was significantly associated with all functional CPET parameters. It could classify HF patients according to the functional capacity and may stratify which patients have a poor prognosis and therefore to deserve more differentiated treatment, such as heart transplantation.