Table 4.
Association of Indices of Cardiac Mechanics with the Combined Outcome of Cardiovascular Hospitalization, Heart Failure Hospitalization, or Death in Heart Failure with Preserved Ejection Fraction
| Independent variable | Unadjusted | Adjusted (Model 1) | Adjusted (Model 2) | Adjusted (Model 3) | ||||
|---|---|---|---|---|---|---|---|---|
| HR* (95%CI) |
P-value | HR* (95%CI) |
P-value | HR* (95%CI) |
P-value | HR* (95%CI) |
P-value | |
| LV longitudinal strain | 1.25 (1.03–1.52) |
0.023 | 1.18 (0.97–1.45) |
0.10 | 1.17 (0.95–1.43) |
0.13 | — | — |
| RV free wall strain | 1.30 (1.07–1.58) |
0.009 | 1.20 (0.98–1.02) |
0.08 | 1.19 (0.97–1.47) |
0.10 | — | — |
| LA conduit strain | 1.74 (1.35–2.24) |
<0.001 | 1.42 (1.07–1.87) |
0.013 | 1.33 (1.00–1.76) |
0.05 | 1.22 (0.91–1.84) |
0.18 |
| LA booster strain | 1.56 (1.23–1.99) |
<0.001 | 1.45 (1.12–1.88) |
0.004 | 1.40 (1.08–1.82) |
0.01 | 1.33 (1.01–1.73) |
0.04 |
| LA reservoir strain | 1.72 (1.37–2.15) |
<0.001 | 1.63 (1.22–2.19) |
0.001 | 1.54 (1.15–2.07) |
0.006 | 1.43 (1.05–1.95) |
0.02 |
| LA stiffness index** | 1.44 (1.27–1.63) | <0.001 | 1.44 (1.22–1.70) |
<0.001 | — | — | 1.39 (1.17–1.66) |
<0.001 |
Per 1-SD decrease in each strain variable; all strain values are presented as absolute values (thus, a decrease in each independent variable indicates worse strain). For LA stiffness index, HRs are per 1-SD increase in the independent variable.
LA stiffness index = E/e’ ÷ LA reservoir strain; thus, Model 2 (which adjusts for E/e’ ratio) does not apply to LA stiffness index since E/e’ is used to calculate the LA stiffness index, and Model 3 for the LA stiffness index includes LV longitudinal strain and RV free wall strain but does not include E/e’.
Model 1 adjusts for sex; atrial fibrillation; MAGGIC risk score (which includes the following variables: age, ejection fraction, creatinine, diabetes, chronic obstructive pulmonary disease, systolic blood pressure, body-mass index, heart rate, New York Heart Association functional class, ACE-inhibitor use, beta-blocker use, heart failure duration, and current smoker); LV mass; and LA volume.
Model 2 adjusts for Model 1 variables + E/e’ ratio (average of septal and lateral E/e’ ratios).
Model 3 adjusts for Model 2 variables + LV longitudinal strain and RV free wall strain.
HR = hazard ratio; CI = confidence interval; LV = left ventricular; RV = right ventricular; LA = left atrial; MAGGIC = Meta-Analysis Global Group in Chronic heart failure.