pressures, decreased cardiac output, and worse New York Heart Association functional class [73]; (3) showing LV mechanical dyssynchrony have significantly higher rates of LV longitudinal systolic (64%) and diastolic (70%) dysfunction than those without dyssynchrony, suggesting that restoration of asynchronous contractions could improve systolic and diastolic longitudinal LV dysfunction, as well as associated symptoms [74]; (4) have significantly more impaired RV longitudinal diastolic (RV global longitudinal early-diastolic strain rate) and systolic (RV global longitudinal systolic strain) function than matched asymptomatic patients with LV diastolic dysfunction, suggesting that RV longitudinal systolic and diastolic dysfunction could contribute to symptoms [75]; and (5) demonstrate significantly reduced LA longitudinal systolic (LA late diastolic strain rate) and diastolic (LA systolic strain and strain rate) function compared to matched asymptomatic patients with LV diastolic dysfunction, suggesting that LA longitudinal systolic and diastolic dysfunction could be related to reduced functional capacity during effort [76]; accordingly, resting global peak LA longitudinal strain during LV systole has significant incremental diagnostic value over clinical and conventional TTE parameters (early diastolic mitral annular velocity ratio, LV mass index, and maximum LA volume index), and diagnostic value is further improved by adding leg-lifting during global peak LA longitudinal strain measurements (global chi-square = 72.2 versus 49.6; P < . 0001) [77]. Peak mitral annular systolic velocity on TEE with TDI is a significant independent predictor of HFpEF, and when used in combination with exercise, it may increase the diagnostic value of models using the variables recommended by the European Society of Cardiology guidelines [78].
Suspected New Onset and Known Nonacute Heart Failure. pressures, decreased cardiac output, and worse New York Heart Association functional class [73]; (3) showing LV mechanical dyssynchrony have significantly higher rates of LV longitudinal systolic (64%) and diastolic (70%) dysfunction than those without dyssynchrony, suggesting that restoration of asynchronous contractions could improve systolic and diastolic longitudinal LV dysfunction, as well as associated symptoms [74]; (4) have significantly more impaired RV longitudinal diastolic (RV global longitudinal early-diastolic strain rate) and systolic (RV global longitudinal systolic strain) function than matched asymptomatic patients with LV diastolic dysfunction, suggesting that RV longitudinal systolic and diastolic dysfunction could contribute to symptoms [75]; and (5) demonstrate significantly reduced LA longitudinal systolic (LA late diastolic strain rate) and diastolic (LA systolic strain and strain rate) function compared to matched asymptomatic patients with LV diastolic dysfunction, suggesting that LA longitudinal systolic and diastolic dysfunction could be related to reduced functional capacity during effort [76]; accordingly, resting global peak LA longitudinal strain during LV systole has significant incremental diagnostic value over clinical and conventional TTE parameters (early diastolic mitral annular velocity ratio, LV mass index, and maximum LA volume index), and diagnostic value is further improved by adding leg-lifting during global peak LA longitudinal strain measurements (global chi-square = 72.2 versus 49.6; P < . 0001) [77]. Peak mitral annular systolic velocity on TEE with TDI is a significant independent predictor of HFpEF, and when used in combination with exercise, it may increase the diagnostic value of models using the variables recommended by the European Society of Cardiology guidelines [78].