Longitudinal Assessment of Left Ventricular Global Longitudinal Strain and NT-proBNP in Predicting Heart Failure with Preserved Ejection Fraction

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is a growing cardiovascular condition, characterized by diastolic dysfunction despite a preserved ejection fraction, often leading to poor prognosis. Objective: To assess the predictive value of left ventricular global longitudinal strain (LV GLS) and NT-proBNP for heart failure progression in HFpEF patients. Methods: This longitudinal study enrolled 152 patients from January 2020 to June 2022 at Duke Clinical Research Institute, Durham, NC. Patients underwent serial echocardiographic imaging for LV GLS measurement and NT-proBNP assays at baseline, 6 months, and 12 months. Statistical analysis, including paired t-tests and linear regression, was performed to assess the correlation between LV GLS, NT-proBNP, and the development of heart failure symptoms. Results: Of the 152 patients, 72% demonstrated significant LV GLS impairment, while NT-proBNP was elevated in 68% of cases at 12 months. The mean LV GLS value was -16.2% ± 3.4%, with a p-value of 0.001. NT-proBNP levels had a mean of 1242 pg/mL ± 580.1, significantly correlated with worsening symptoms (p = 0.003). Multivariate regression analysis showed a significant predictive relationship between combined LV GLS and NT-proBNP for predicting heart failure progression (R² = 0.63, p < 0.01). Conclusion: LV GLS and NT-proBNP are strong predictors of heart failure progression in HFpEF patients, supporting their combined use for early identification of at-risk individuals.