SPC365

Left ventricular global longitudinal strain is associated with invasive filling pressures and cardiac output in the ambulatory setting: insights from the CardioMEMS™

Session: Sessão de Posters 33 - Insuficiência cardíaca - Avaliação de exercício
Speaker: Francisco Barbas de Albuquerque

Congress: CPC 2024
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.6 Chronic Heart Failure - Clinical
Session Type: Cartazes
FP Number: ---
Authors: Francisco Barbas De Albuquerque; Ana Rita Teixeira; Tiago Pereira-Da-Silva; Vera Ferreira; António Gonçalves; Rita Ilhão Moreira; Ana Teresa Timóteo; Ana Galrinho; Pedro Rio; Luísa Moura Branco; Duarte Cacela; Rui Ferreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Background:</span></span></strong> </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Left ventricular global longitudinal strain (LVGLS) is a powerful indicator of myocardial function in patients with heart failure with reduced ejection fraction (HFrEF). Nevertheless, it is not clear whether LVGLS correlates with filling pressures and cardiac output (CO) in the ambulatory setting.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Aim</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">We aimed to assess whether LVGLS is associated with invasive pulmonary artery pressures (PAP) and CO in outpatients using the remote monitoring CardioMEMS&trade; system.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Methods: </span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">This single-center, prospective observational study included patients with HFrEF undergoing remote monitoring using the CardioMEMS<sup>TM</sup> system, between January 2020 and December 2022. Repeated transthoracic echocardiography (TTE) studies were performed in each patient and invasive hemodynamic data were obtained at the moment of TTE studies using the CardioMEMS<sup>TM</sup> system. Univariate and multivariate models were used to assess the potential association between LVGLS and invasive measurements of PAP and CO.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Results:</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">&nbsp;Twelve patients were included and 46 TTE studies were analyzed. In overall population, the median age was 67 (11), 92% were male, 8 (67%) had ischemic dilated cardiomyopathy. Median LVEF was 28.5 (8) %, median LVGLS was -7.3 (3) and mean NT-proBNP was 5032 &plusmn; 4518.1 pq/mL. All patients were on optimized guideline-directed medical therapy (GDMT). Nine (75%) patients had an implantable cardiac device (ICD) and 2 (16.7%) had cardiac resynchronization therapy (CRT). Five patients had more than one HFH and 4 (33%) received levosimendan in the previous year.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">LVGLS was correlated with diastolic PAP (r=0.403, p=0.041) and CO (r= - 0.426, p=0.039) in the univariate analysis (Figure 1), but not&nbsp;with systolic PAP and mean PAP. In multivariate models, LVGLS was an independent predictor of dPAP (figure 1). This model explains 60% of dPAP value (R<sup>2</sup>=0.60, adjusted R<sup>2</sup> = 0.56, p &lt; 0.001). A 1% rise in the absolute LVGLS value is associated with an increase of 1.3 mmHg in dPAP (p &lt; 0.001), when adjusted for sPAP estimation by echocardiography. In addition,&nbsp;</span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">LV </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">GLS was the only independent predictor of CO value. This model explains 36% of CO value R<sup>2</sup>= 0.362, <em><span style="font-family:&quot;Aptos&quot;,sans-serif">p</span></em>=0.001). Incrementing 1% in LVGLS is associated with a decrease of 0.38 L/min of CO.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Furthermore, the variation of LVGLS was correlated with the variation of dPAP during follow-up (r=0.60, p=0.017) (figure 1).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">Conclusion:</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Aptos&quot;,sans-serif">&nbsp;In a cohort of HFrEF patients with invasive hemodynamic remote monitoring, LVGLS was independently associated with invasive filling pressures and CO in the ambulatory setting. These findings reinforce the value of LVGLS for the management of HFrEF in this clinical context.</span></span></span></span></p>