Left ventricular global function index: prognostic value in patients with heart failure aged 60 years and older

Left ventricular (LV) global function index (LVGFI) is a novel marker that incorporates the functional and structural characteristics of the LV.

Aim. To evaluate the prognostic value of LVGFI in outpatients with heart failure with preserved ejection fraction (HFpEF) aged 60 years and older.

Material and methods. The study included 78 patients (male, 42%) aged 74 (67-77) years with NYHA class II-III heart failure. LVGFI was defined as LV stroke volume/LV global volume х 100, where LV global volume was the sum of the LV mean cavity volume ((LV end-diastolic volume + LV end-systolic volume)/2) and myocardial volume (LV mass/ density).

Results. The median LVGFI was 21,7% (interquartile range 19,3 to 22,9%). Higher NYHA class of HF was associated with worse LVGFI:

class II HF was associated with LVGFI of 22,0 (20,3-23,1)%, class III HF — with 20,4 (17,5-22,4)%. During the 3—month (24-48) follow-up period, 15 (19,2%) patients died. Among patients with NYHA class II HF, 6 out of 61 (9,8%) died, with class III HF — 9 out of 17 (53,0%) (p<0,001). According to ROC analysis, the optimal LVGFI cut-off point for the prediction of an unfavorable prognosis in patients with HFpEF aged 60 years was ≤21,1% (p<0,001). The sensitivity was 73,3%, specificity — 70,0%. Patients with LVGFI ≤21,1% had significantly lower survival: among patients with LVGFI ≤21,1%, 11 out of 30 (36,7%) died; among those with LVGFI >21,1%, 4 out of 48 (8,3 %) died (p=0,016).

Conclusion. Higher NYHA class of HF was associated with worse LVGFI. Patients with lower LVGFI have significantly lower survival. The optimal LVGFI cut-off point for the prediction of an unfavorable prognosis in patients with HFrEF aged 60 years was <21,1%.

1. Mareev VY, Fomin IV, Ageev FT, et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8-158. (In Russ.) doi:10.18087/cardio.2475.

2. Mewton N, Opdahl A, Choi EY, et al. Left ventricular global function index by magnetic resonance imaging — a novel marker for assessment of cardiac performance for the prediction of cardiovascular events: the multi-ethnic study of atherosclerosis. Hypertension. 2013;61(4):770-8. doi: 10.1161/HYPERTENSIONAHA.111.198028.

3. Eitel I, Poss J, Jobs A, et al. Left ventricular global function index assessed by cardiovascular magnetic resonance for the prediction of cardiovascular events in ST-elevation myocardial infarction. J Cardiovasc Magn Reson. 2015;16;17:62. doi:10.1186/s12968-015-0161-x.

4. Reinstadler SJ, Klug G, Feistritzer HJ, et al. Prognostic value of left ventricular global function index in patients after ST-segment elevation myocardial infarction. Eur Heart J Cardiovasc Imaging. 2016;17(2):169-76. doi:10.1093/ehjci/jev129.

5. Nwabuo CC, Moreira HT, Vasconcellos HD, et al. Left ventricular global function index predicts incident heart failure and cardiovascular disease in young adults: the coronary artery risk development in young adults (CARDIA) study. Eur Heart J Cardiovasc Imaging. 2019;20(5):533-40. doi: 10.1093/ehjci/jey123.

6. Lang R, Badano L, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. doi:10.1016/j.echo.2014.10.003.

7. Schiller N, Osipov MA. Clinical echocardiography. 2nd edition. M.: Practice, 2005. 344 p. (In Russ.) ISBN 589816049-3.