ABC | Volume 113, Nº2, August 2019

Original Article Global Longitudinal Strain Predicts Poor Functional Capacity in Patients with Systolic Heart Failure Rafael José Coelho Maia, 1 Simone Cristina Soares Brandão, 1 Jéssica Leite, 2 Giordano Bruno Parente, 3 Filipe Pinheiro, 2 Bruna Thays Santana Araújo, 2 Maria Inês Remígio Aguiar, 1 Sílvia Marinho Martins, 4 Daniella Cunha Brandão, 2 Armele Dornelas de Andrade 1 Universidade Federal de Pernambuco - Ciências da Saúde, 1 Recife, PE – Brazil Universidade Federal de Pernambuco – Fisioterapia, 2 Recife, PE – Brazil Hospital Agamenon Magalhaes – Cardiologia, 3 Recife, PE – Brazil Pronto Socorro Cardiológico de Pernambuco (PROCAPE) - Ambulatório de Doença de Chagas e Insuficiência Cardíaca, 4 Recife, PE – Brazil Mailing Address: Simone Cristina Soares Brandão • Universidade Federal de Pernambuco – Pós-Graduação em Ciências da Saúde - Av. Professor Moraes Rego, 1235. Postal Code 50670-901, Cidade Universitária, Recife, PE – Brazil E-mail: sbrandaonuclearufpe@gmail.com Manuscript received July 19, 2018, revised manuscript October 28, 2018, accepted November 14, 2018 DOI: 10.5935/abc.20190119 Abstract 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. (Arq Bras Cardiol. 2019; 113(2):188-194) Keywords: Heart Failure;Longitudinal Strain; Torsion,Mechanical; Torsion Abnormality; Ventricular Dysfunction, Left; Echocardiography, Doppler/methods. Introduction The cardiopulmonary exercise test (CPET) is the gold standard method for assessing functional capacity in patients with heart failure (HF). It is able to measure during exercise, maximum myocardial oxygen consumption (maxVO 2 ), CO 2 production, ratio minute ventilation/carbon dioxide production VE/VCO 2 slope, VO 2 recovery kinetics after physical exertion (T 1/2 VO 2 ), stratify cardiovascular risk and predict mortality and hospitalization by these parameters, for example, VO 2 values < 14 mL/kg/min and VE/VCO 2 slope >35 that are criteria for heart transplantation. 1-4 Furthermore, CPET evaluates the presence of dysautonomia, by measuring the reduction in heart rate within the first minute after exercise (HRR), 5,6 which is directly related to cardiovascular outcome. 7-9 However, in patients with systolic HF, the reduction of myocardial contractility, measuredmainly by echocardiography through the left ventricular ejection fraction (LVEF), is the main parameter used to classify the myocardial damage degree, 10 although its value is little associated with the clinical symptoms and functional capacity of these patients. 1,10 The strain analysis is a newer echocardiography tool and has demonstrated more effective in assessing global derangement of the left ventricle (LV) than the LVEF measurement. 10 Recent studies show that the left ventricular global longitudinal strain value (GLS) can predict functional capacity in patients with HF and preserved LVEF, 11 and assess prognosis in HF with reduced LVEF when compared with life expectancy scores. 12 Additionally, this technique evaluates the degree of myocardial deformation and it seems to predict the degree of regional and global LV fibrosis. 13 However, there are no studies comparing the GLS with CPET parameters 188