Relation Between Echocardiogram-Based Cardiac Parameters and Outcome in Heart Failure With Preserved and Reduced Ejection Fraction

The purposes of this study were to investigate whether heart failure (HF) with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) share echocardiographic predictors and elucidate E/(e′ × s′) that predicts major adverse cardiovascular events (MACE) independent of other echocardiographic parameters in each HF group. We assessed tissue Doppler-derived parameters [E/e′, E/(e′ × s′)] and left ventricular and right ventricular longitudinal strains in HFrEF (n = 340) and HFpEF (n = 102). Left ventricular and right ventricular longitudinal strains were significantly higher and E/(e′ × s′) was lower in patients with HFpEF compared with those with HFrEF, whereas E/e′ was similar between the groups. During a median follow-up of 342 days, MACE developed in 95 patients with HFrEF and 29 with HFpEF. The univariable analysis revealed similar echocardiographic predictors between the 2 groups, including E/e′, E/(e′ × s′) and pulmonary artery systolic pressure. No 2-dimensional speckle tracking-derived parameter remained significant in multivariable models in each HF group. E/(e′ × s′) was an only independent predictor with an incremental prognostic value over the Meta-analysis Global Group in Chronic Heart Failure score and was superior to the E/e′ ratio in both HFrEF and HFpEF. In conclusion, despite differences in echocardiography-based cardiac function parameters between HFrEF and HFpEF, these HF phenotypes shared the same echocardiographic predictors of future MACE. E/(e′ × s′) was an only independent predictor for future cardiac events in both HF populations.