In heart failure (HF), most of the data available on myocardial strain focused on left heart cavities.

Our study aimed to assess four chambers strain profiles in patients with HF.

We prospectively evaluated 95 patients hospitalized for HF. Patients were divided into preserved LVEF (LVEF ≥ 50%, HFpEF n=24), mildly reduced LVEF ((LVEF 41–49%, HFmrEF n=17), and reduced left ventricular ejection fraction (LVEF) (LVEF ≤ 40%, HFrEF n=54). In addition to the usual two-dimensional echocardiographic parameters, LV global longitudinal strain, left and right atrial strain (reservoir, conduit, contractile strain) and right ventricular free wall strain were measured using speckle tracking transthoracic echocardiography at admission.

Patients with HFrEF were younger in comparison with patients with HFmrEF and HFpEF, (respectively 66.3±14.2, 78.3.0±8.7, 75.6±10.2 years P<0.001). They were no differences in the prevalence of cardiovascular risk factors and in the history of AF between the 3 groups. Patients with HFrEF had higher LV end-diastolic volume in comparison with patients with HFmrEF and HFpEF (respectively 89.7 (63.9–109.5), 68.6 (49.7–76.0), 41.9 (34.2–48.1) mL/m², P<0.001). They were no differences between the 3 groups regarding diastolic function parameters (E/A, E/e’, left atrial indexed volume), the right atrial indexed volume and the tricuspid lateral annular peak systolic velocity (S’). Tricuspid regurgitation (TR) peak velocity was significantly lower in HFmrEF group (P=0.008). Myocardial strain analyses demonstrated that patients with HFrEF had significant lower LV global and right ventricular strain, lower left atrial reservoir strain, lower left and right atrial conduit strain (Fig. 1).

Beyond the alteration of LV function, HFrEF involves alteration of RV, LA and RA functions. Strain analysis is an interesting tool in addition to conventional echocardiographic parameters to assess heart function in heart failure. The prognostic impact of these finding remains to be studied.