Increase left ventricular (LV) filling pressure strongly impacts on heart failure (HF) prognosis. Diastolic global strain rate (E’SR) by speckle tracking appears superior to tissue Doppler imaging (TDI) in assessing of LV filling pressure. However, their prognosis value in HF patients has never been compared.

The study included 120 consecutive symptomatic HF patients (63±16 years, 77% male, LVEF=31±10%, 61% NYHA III–IV). LV filling pressure was assessed by the ratio of early diastolic mitral pulsed Doppler (E) over E’SR by speckle tracking computed from strain rate curves of apical views. E/E’SR was compared to E/E’TDI and the occurrence of major adverse cardiac events (MACE).

E/E’ averaged 18.4±11.9 by speckle tracking and correlated with the severity of NYHA functional class (11.4±3.8 vs 18.7±8.1 p=0.02 for class I and class II–IV, respectively), BNP value (r=0.27 p=0.02), LVEF (r=0.25 p=0.006) and E’/E’ by TDI (r=0.57 p<0.0001). During the follow-up period (266±177 days), MACE occurred in 47 (38%) patients (15 death, 29 recurrent HF and 4 heart transplantations). By univariable analysis, E/E’SR and E/E’TDI were associated with the occurrence of MACE. But, only E/E’SR (OR 1.43, p=0.02) and LVEF (OR 0.95, p=0.004) remained associated to outcome by multivariate analysis. Importantly, E/E’SR>18 (optimal cut-off value defined by ROC curves,) was associated with an increase of risk of MACE by 4 (Figure).

LV filling pressure by speckle tracking is superior to TDI to predict outcome in HF patients.