Impaired global longitudinal strain in elderly patients with preserved ejection fraction is associated with raised post-exercise left ventricular filling pressure

Background The purpose of this study was to evaluate whether impaired resting global longitudinal strain (GLS) in elderly patients with preserved left ventricular (LV) ejection fraction (EF) is associated with raised post-exercise LV filling pressure estimated by the ratio of early diastolic transmitral flow velocity to annulus velocity (E/e '). Methods Seventy elderly patients (age = 74 +/- 6 years, male 40 patients) who underwent treadmill stress echocardiography were studied. All patients had normal sinus rhythm, normal LV wall motion at rest, and had preserved LVEF >= 50%. Patients with exercise induced wall motion abnormality were not included. GLS at rest was measured using automated functional imaging. Results Twenty-four of the 70 patients had raised post-exercise LV filling pressure indicated by septalE/e ' >= 15.0. Patients with raised post-exercise LV filling pressure had smaller resting GLS than that in patients without it (- 16.9 +/- 1.8 vs. - 19.6 +/- 2.5%, respectively,p < 0.0001). Downward stepwise multivariate logistic regression analysis demonstrated that resting GLS was one of independent predictors of raised post-exerciseE/e '. Receiver operating characteristic (ROC) curve analysis had demonstrated that optimal cutoff point for resting GLS to predict raised post-exerciseE/e ' was - 17.8% (sensitivity 83.3%, specificity 80.4%, respectively), and the area under the ROC curve was 0.820. Conclusion In elderly patients with preserved LVEF and without obvious myocardial ischemia, impaired resting GLS at rest is associated with raised post-exercise LV filling pressure estimated byE/e ' >= 15.0.