Left Ventricle Diastolic Wall Strain as a Simple Parameter of In-hospital Mortality in Heart Failure with Reduced Ejection Fraction (HFREF) Patients


  • Andrico Tobing Universitas Prima Indonesia




DWS, Diastolic dysfunction


Background: Abnormality of Left ventricle (LV) relaxation and LV stiffness are the major parts of LV diastolic dysfunction which have an important role in heart failure patients. Left ventricle Diastolic wall strain (DWS) is a non-invasive, load-independent, and reproducible estimator of LV stiffness using 2-D echocardiography based on linear elastic theory. Some studies have revealed the robust role of LV stiffness in heart failure with preserved ejection fraction (HFPEF) patients, but role and prognostic value of this parameter remains unclear in HFrEF. Methods: We studied 40 patients with signs and symptoms of heart failure (EF < 50%) between September to December 2017. Patients with the history of cardiac surgery, moderate to severe valvular heart disease, atrioventricular block, constrictive pericarditis, atrial fibrillation and old myocardial infarction in posterior wall are excluded. DWS was measured using the formula: DWS = [(LV posterior wall thickness at end systole − LV posterior wall thickness at end-diastole)/LV posterior wall thickness at end-systole]. All patients diverged into 2 groups (with and without in-hospital mortality) and DWS results were compared. Results: A total of 40 patients, 9 females (22%), with average age 59.6 ± 9.38 years. Hypertension in 18 patients (45%), type 2 Diabetes 22 patients (55%), Dyslipidemia 27 patients (67%). We found 14 patients (35%) with mortality in hospitalization. E/A ratio, E/E’ and DWS were significantly associated with in-hospital mortality. Between groups, DWS was significantly lower in patients with in-hospital mortality by 0.14  0.09 vs 0.22 ± 0.08 (P = 0.008). Although it is not statistically significant, lower DWS conversely related to diastolic dysfunction severity. Conclusion: DWS is associated with more severe outcome in HFrEF patients. As a simple and non-invasive parameter of LV stiffness, DWS can be useful to predict poor prognosis of HFrEF patients.


Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol 2011;8:30–41.

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation 2015;131:e29–322.

Watanabe S, Shite J, Takaoka H, Shinke T, Imuro Y, Ozawa T, et al. Myocardial stiffness is an important determinant of the plasma brain natriuretic peptide concentration in patients with both diastolic and systolic heart failure. Eur Heart J 2006;27:832–8.

Zile MR, Baicu CF, Ikonomidis JS, Stroud RE, Nietert PJ, Bradshaw AD, et al. Myocardial stiffness in patients with heart failure and a preserved ejection fraction: contributions of collagen and titin. Circulation 2015;131:1247–59.

Nakano K, Sugawara M, Ishihara K, Kanazawa S, Corin WJ, Denslow S, et al. Myocardial stiffness derived from end-systolic wall stress and logarithm of reciprocal of wall thickness. Contractility index independent of ventricular size. Circulation 1990;82:1352–61

Takeda Y, Sakata Y, Higashimori M, et al. Noninvasive assessment of wall distensibility with the evaluation of diastolic epicardial movement. J Card Fail. 2009;15(1):68-77.

Soyama Y, Mano T, Goda A, et al. Prognostic value of diastolic wall strain in patients with chronic heart failure with reduced ejection fraction. Heart Vessels. 2016;32(1):68-75.

Ohtani T, Mohammed SF, Yamamoto K, et al. Diastolic stiffness as assessed by diastolic wall strain is associated with adverse remodelling and poor outcomes in heart failure with preserved ejection fraction. Eur Heart J. 2012;33(14):1742-9

Selvaraj S, Aguilar F, Martinez E, et al. Diastolic wall strain: a simple marker of abnormal cardiac mechanics Cardiovascular Ultrasound 2014, 12:40

Minamisawa M, Miura T, Motoki H, et al. Prognostic Impact of Diastolic Wall Strain in Patients at Risk for Heart Failure. Int Heart J 2017, 58(2):250-6




How to Cite

Tobing, A. (2021). Left Ventricle Diastolic Wall Strain as a Simple Parameter of In-hospital Mortality in Heart Failure with Reduced Ejection Fraction (HFREF) Patients. PRIMER (Prima Medical Journal), 6(1). https://doi.org/10.34012/pmj.v4i1.1539