The main management strategy of heart failure with preserved ejection fraction (HFpEF) is prevention since HFpEF is linked to a high risk for both mortality and recurrent HF hospitalizations. As HFpEF is associated with many cardiovascular (CV) risk factors, the need for an early detection of patients with increased risk for heart failure is of utmost importance.
It has been shown that the systolic function is impaired in HFpef while the left ventricular ejection is preserved. However, global strain values while affected in HFpEF are still preserved in patients with CV risk factors but without HFpEF. Regional strain assessment by CMR seems to be superior in describing deformation impairment in HF. The MyoHealth score reflects a ratio between LV segments with preserved and total number of segments and is a promising tool to identify cardiac changes early. We aimed to explore the relevance of the MyoHealth score in a population at risk for HF.  

 

HF patients irrespective of LVEF and asymptomatic controls were recruited, and CMR based measures were obtained.

For this analysis the asymptomatic control group (n=19) was divided into asymptomatic subjects without CV co-morbidities or evidence of cardiac abnormalities and (n=12) and asymptomatic subjects with CV co-morbidities or evidence of cardiac abnomalities (n=7). We performed CMR scans at rest and during a stress test using isometric handgrip exercise (HG).

Assessing the MyoHealth score at rest revealed preserved regional strain in 85±9% of LV segments in controls, 73±11% in At Risk subjects and 73±8% in HFpEF patients. During stress the MyoHealth score was 84±7% in controls, 83±7 in At Risk subjects and 74±11 in HFpEF patients.

In summary, we show for the first time that asymptomatic subjects with increased CV risk present with HFpEF like impaired myocardial deformation at rest, while they show results like controls under HG stress. The potential of preventive treatment in this group of patients merits further investigation in future.