Left ventricular myocardial constructive work predicts reduction of ejection fraction in patients with heart failure with preserved ejection fraction

We aimed to found predictors of EF deterioration in HFpEF patients toprevent their further deterioration. Methods. We studied 215 patients(63% women) 73±8 years with HFpEF and with records of Charlson index(CI), glomerular filtration rate (GFR). Myocardial work (MW), globallongitudinal (LS), radial (RS), circumferential (SS) and area strain(AS).GW index , global constructive work (GCW), wasted work, GWefficiency were obtained by echocardiography. Patients followed up for 3years. Results. 5 patients developed myocardial infarction and wereexcluded from the study.Baseline EF was higher in women (61,2 ± 3,1 vs56,4 ± 2,7; P<0.002), in patients >70 years (62,4 ± 2,1 vs 57,1 ± 2,3;p<0.005), and with end-diastolic volume index <60 ml/m2 (56,1 ± 3,2vs 63,4 ± 2,3; p<0.001). EF decline compared to baseline was -7.3 ±1.6%, p<0.01. EF decline was significantly more in patients >70 years, inpatients with coronary artery disease and did not relate to sex, LV size,CI, and GFR. During follow up 58(27%) patients had EF<50%.,worsening in AS (-27.9±8.5% vs -24.7±5.3%, p<0.003), LS (-19.7±2.4% vs -17.1±1.6%, p<0.005), and GCW (2378±117 vs2102±10, p<0.002). Patients with EF <50% at the end of the study hadless AS and GCWbaseline values compared with patients with EF>50% (22.4±7.2% vs -27.6±8.1%,p<0.002; 2081±92 vs 2489±127, p<0.001). GCW was thepredictor of EF deterioration(area under curve 0,8853). Conclusion. GCW predicts EF decline in HFpEF patients which may help earlieridentify this subset of patients and prevent their furtherdeterioration.