Shinzato Mariane Higa, Santos Natasha, Nishida Gustavo, Moriya Henrique, Assef Jorge, Feres Fausto, Hortegal Renato A
Dante Pazzanese Institute of Cardiology, São Paulo, SP, Brazil, Av. Dr. Dante Pazzanese, 500, 04012909.
Biomedical Engineering Laboratory, University of Sao Paulo, São Paulo, Brazil.
Cardiovasc Ultrasound. 2024 Mar 4;22(1):4. doi: 10.1186/s12947-024-00323-1.
Heart failure with preserved ejection fraction (HFpEF) represents a significant proportion of heart failure cases. Accurate diagnosis is challenging due to the heterogeneous nature of the disease and limitations in traditional echocardiographic parameters.
This review appraises the application of Global Longitudinal Strain (GLS) and Left Atrial Strain (LAS) as echocardiographic biomarkers in the diagnosis and phenotyping of HFpEF. Strain imaging, particularly Speckle Tracking Echocardiography, offers a superior assessment of myocardial deformation, providing a more detailed insight into left heart function than traditional metrics. Normal ranges for GLS and LAS are considered, acknowledging the impact of demographic and technical factors on these values. Clinical studies have demonstrated the prognostic value of GLS and LAS in HFpEF, especially in predicting cardiovascular outcomes and distinguishing HFpEF from other causes of dyspnea. Nevertheless, the variability of strain measurements and the potential for false-negative results underline the need for careful clinical interpretation. The HFA-PEFF scoring system's integration of these biomarkers, although systematic, reveals gaps in addressing the full spectrum of HFpEF pathology. The combined use of GLS and LAS has been suggested to define HFpEF phenogroups, which could lead to more personalized treatment plans.
GLS and LAS have emerged as pivotal tools in the non-invasive diagnosis and stratification of HFpEF, offering a promise for tailored therapeutic strategies. Despite their potential, a structured approach to incorporating these biomarkers into standard diagnostic workflows is essential. Future clinical guidelines should include clear directives for the combined utilization of GLS and LAS, accentuating their role in the multidimensional assessment of HFpEF.
射血分数保留的心力衰竭（HFpEF）占心力衰竭病例的很大比例。由于该疾病的异质性以及传统超声心动图参数的局限性，准确诊断具有挑战性。
本综述评估了整体纵向应变（GLS）和左心房应变（LAS）作为超声心动图生物标志物在HFpEF诊断和表型分析中的应用。应变成像，尤其是斑点追踪超声心动图，能对心肌变形进行更优评估，比传统指标更深入地洞察左心功能。考虑了GLS和LAS的正常范围，同时认识到人口统计学和技术因素对这些值的影响。临床研究已证明GLS和LAS在HFpEF中的预后价值，特别是在预测心血管结局以及区分HFpEF与其他呼吸困难原因方面。然而，应变测量的变异性和假阴性结果的可能性强调了临床谨慎解读的必要性。HFA-PEFF评分系统对这些生物标志物的整合虽具系统性，但在涵盖HFpEF病理全谱方面存在不足。有人建议联合使用GLS和LAS来定义HFpEF表型组，这可能会带来更个性化的治疗方案。
GLS和LAS已成为HFpEF无创诊断和分层的关键工具，为量身定制治疗策略带来希望。尽管它们具有潜力，但将这些生物标志物纳入标准诊断工作流程的结构化方法至关重要。未来的临床指南应包括关于联合使用GLS和LAS的明确指导，突出它们在HFpEF多维评估中的作用。
