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Resting global and regional left ventricular contractility in patients with heart failure and normal ejection fraction: insights from speckle-tracking echocardiography
  1. Gabriel Wai-Kwok Yip1,2,
  2. Qing Zhang1,3,
  3. Jun-Mei Xie1,
  4. Yu-Jia Liang1,2,
  5. Ying-Mei Liu1,2,
  6. Bryan Yan1,2,
  7. Yat-Yin Lam1,2,
  8. Cheuk-Man Yu1,2
  1. 1Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Peoples' Republic of China
  2. 2Translational Medicine Research & Development Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
  3. 3Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, Peoples' Republic of China
  1. Correspondence to Professor Cheuk-Man Yu, Division of Cardiology, 9/F Clinical Science Building, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Peoples' Republic of China; cmyu{at}


Obejctive To compare left ventricular (LV) systolic performance and contractility in patients with heart failure and normal ejection fraction (HFNEF), compared with patients with heart failure and reduced ejection fraction (HFREF) and healthy subjects using newer echocardiographic techniques.

Design A case–control trial.

Setting University teaching hospital (tertiary referral centre).

Patients Sixty healthy control subjects (53±10 years), 112 patients with HFNEF (74±12 years) and 175 patients with HFREF (67±13 years).

Interventions All underwent standard two-dimensional, Doppler and speckle-tracking echocardiography.

Main outcome measures Effective arterial (Ea) and LV end-systolic elastance (Ees), stress-corrected mid-wall shortening, preload recruitable stroke work, two-dimensional strain and torsion. Comparisons were adjusted for age, gender and body size.

Results Besides diastolic dysfunction, patients with HFNEF had impaired load-independent ventricular contractility with a progressive decrease of the corrected Ees from controls (2.9±0.8 mm Hg/g) to HFNEF (2.2±0.9 mm Hg/g) followed by HFREF (0.8±0.3 mm Hg/g; all p<0.001). Ventricular-arterial coupling ratio was preserved in the HFNEF subgroup (normal 0.48±0.09 vs 0.65±0.16; p=NS) at the expense of both increased LV systolic stiffness and Ea. In addition, there was progressive decrease of global 2D circumferential, radial and longitudinal strain as well as torsion from normal, HFNEF to HFREF groups, even after adjustment for LV end-systolic wall stress or end-diastolic volume (all p<0.01). About 50% of patients with HFNEF had ≥1 global strain or torsion parameter depressed below normal after correction for LV end-systolic wall stress, with >85% falling below their corresponding stress-corrected mean.

Conclusions Impaired myocardial contractility is evident in many patients with HFNEF and this may contribute towards pathophysiology of HFNEF more than previously thought.

  • Contractility
  • heart failure
  • echocardiography
  • tissue Doppler

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  • Funding This research was funded by General Research Fund (project #479509) from the Research Grants Council of Hong Kong.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Joint The Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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