Afterload increase challenge unmasks systolic abnormalities in heart failure with preserved ejection fraction

Autor(es)

Hortegal, Renato A. ; Valeri, Renata ; Grizante, Mariana ; Cancellier, Renato ; Gun, Carlos ; Assef, Jorge ; Moriya, Henrique ; Meneghelo, Romeu ; Feres, Fausto ; Franchini, Kleber G.

• Tipo de documento: Artigo Científico
• Fonte: INTERNATIONAL JOURNAL OF CARDIOLOGY; v. 380, p. 8-pg., 2023-04-19.

Resumo

Background: Provocative maneuvers have the potential to overcome the low sensitivity of resting echocardiog-raphy and biomarkers in the detection of heart failure with preserved ejection fraction (HFpEF). We investigate the mechanical response of the left ventricle to an afterload challenge in patients with preclinical and early-stage HFpEF (es-HFpEF).Methods: Three groups of patients (non-HFpEF -n = 42, pre-HFpEF -n = 43, and es-HFpEF -n = 39) underwent echocardiography at rest and during an afterload challenge induced by handgrip maneuver combined with pneumatic constriction of limbs.Results: Patients in the non-HF group displayed a median ALPSS =-4% (IQR:-10%, +2%), LPSS rest<16% in 3/42(7%) and LPSS stress<16% in 6/43(14%). Subjects in the pre-HFpEF group displayed median ALPSS =-3% (IQR:-10%, +5%) LPSS rest<16% in 13/43(30%) and LPSS stress<16% in 19/43 (44%). 11/43 (25%) subjects in this group increased at least one absolute point in LPSS during stress. Patients in es-HFpEF group displayed a median ALPSS =-10% (IQR:-18%,-1%), LPSS rest<16% in 15/39 (38%) and LPSS stress<16% in 25/39(64%). Changes in LPSS (ALPSS) were significantly greater in es-HFpEF than pre-HFpEF (p = 0.022). In multivariate analysis, this group effect was maintained after adjustment of the LPSS for systolic blood pressure, use of 8-blockers, LV mass, RWT, age, and sex.Conclusion: Our data suggest that patients with HFpEF have a marked decrease in peak strain during acute pressure overload. Longitudinal studies are needed to test and compare the clinical impact of each pattern in early and long-term follow-ups. (AU)

• Processo FAPESP: 17/50342-6 - Plano de desenvolvimento institucional em pesquisa (PDIp)
• Beneficiário: Fausto Feres
• Modalidade de apoio: Auxílio à Pesquisa - Programa Modernização de Institutos Estaduais de Pesquisa