Prognostic Factors After Index Hospitalization for Heart Failure With Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) has a high clinical burden and constitutes approximately 20% to 30% of patients with heart failure in Asia. Impaired global longitudinal strain (GLS), defined as an absolute value of <15.8%, has been shown to be a predictor of heart failure hospitalization, cardiovascular death, and aborted cardiac arrest in HFpEF. We sought to validate this finding in our Asian cohort and identify other prognostic factors in HFpEF. In this cohort study, we included all patients with an index hospitalization for heart failure and left ventricular ejection fraction of >45%, from January 1, 2012, to December 31, 2012. All patients had follow-up for at least 3 years. In our study, the absolute value of mean GLS was impaired at 13.50 ± 4.00%, whereas mean left ventricular ejection fraction was 52.00 ± 7.67%. In multivariate Cox regression, impaired GLS of absolute value <15.8% (hazard ratio 4.72, 95% CI 1.25 to 17.81, p = 0.022), every unit increase in age-adjusted Charlson Comorbidity Index (hazard ratio 1.46, 95% CI 1.03 to 2.05, p = 0.031) and low body mass index <18.5 kg/m2 (hazard ratio 4.30, 95% CI 1.25 to 14.78, p = 0.020) were associated with a shorter time to mortality over the 3-year period. Our study validates absolute GLS value of <15.8% to be a prognostic marker for patients with HFpEF.