Diastolic posterior wall strain as a diagnostic tool for heart failure with preserved ejection fraction in ICU patients

Heart Failure with Preserved Ejection Fraction (HFpEF) is a complex clinical syndrome that remains challenging to diagnose due to the limitations of traditional echocardiographic parameters, which are often influenced by loading conditions and technical variability. Diastolic Wall Strain (DWS), a novel echocardiographic index based on the relative thinning of the posterior left ventricular wall during diastole, has emerged as a promising marker of myocardial stiffness and diastolic dysfunction. This study aims to evaluate the utility of posterior wall DWS in diagnosing HFpEF, and to determine its correlation with conventional echocardiographic measures of diastolic function. Along with the possibility of using DWS in assessment of the severity of the disease in the ICU patients. A prospective observational study was conducted on 60 patients with dyspnea and preserved ejection fraction in the ICU. DWS PW was measured using M-mode echocardiography and compared against established parameters, including diastolic dysfunction grading according to EACVI last guidelines (E/e′ ratio and left atrial volume index, etc.) and H2FPEF score for diagnosing Heart failure with preserved ejection fraction according to 2022 AHA guidelines. In addition to the relation between DWS PW and the clinical state assessed clinically and with imaging including lung ultrasound and chest x-ray. The study found that 32 patients with HFpEF exhibited significantly lower DWS values compared to control subjects. DWS showed a strong inverse correlation with Diastolic Dysfunction grading and was independently associated with echocardiographic markers of elevated filling pressure including E/E`. In addition DWS showed a strong inverse correlation with H2FpEF score with 70% of the patient had H2FpEF score above 6 had significantly low DWS. Furthermore DWS significantly reduced with patients that showed lung congestion with the mean DWS 21.2 ± 7.4. A DWS threshold of < 0.27 demonstrated a sensitivity of 78% and specificity of 90% for identifying HFpEF by H2FPEF score. And a DWS threshold of < 0.29 demonstrated a sensitivity of 90% and specificity of 85% for identifying grade II or more Diastolic Dysfunction. Posterior wall Diastolic Wall Strain is a simple, reproducible, and load-independent echocardiographic parameter that offers valuable diagnostic information in patients with HFpEF. Its incorporation into routine echocardiographic assessment may enhance early detection and improve diagnostic accuracy in this increasingly prevalent condition.