AimsThe optimal echocardiographic predictors of cardiovascular outcome in heart failure (HF) with preserved ejection fraction (HFpEF) are unknown. We aimed to identify independent echocardiographic predictors of cardiovascular outcome in patients with HFpEF.Methods and resultsSystematic literature search of three electronic databases was conducted from date of inception until November 2022. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for echocardiographic variables from multivariate prediction models for the composite primary endpoint of cardiovascular death and HF hospitalization were pooled using a random effects meta‐analysis. Specific subgroup analyses were conducted for studies that enrolled patients with acute versus chronic HF, and for those studies that included E/e′, pulmonary artery systolic pressure (PASP), renal function, natriuretic peptides and diuretic use in multivariate models. Forty‐six studies totalling 20 056 patients with HFpEF were included. Three echocardiographic parameters emerged as independent predictors in all subgroup analyses: decreased left ventricular (LV) global longitudinal strain (HR 1.24, 95% CI 1.10–1.39 per 5% decrease), decreased left atrial (LA) reservoir strain (HR 1.30, 95% CI 1.13–1.1.50 per 5% decrease) and lower tricuspid annular plane systolic excursion (TAPSE) to PASP ratio (HR 1.17, 95% CI 1.07–1.25 per 0.1 unit decrease). Other independent echocardiographic predictors of the primary endpoint were a higher E/e′, moderate to severe tricuspid regurgitation, LV mass index and LA ejection fraction, although these variables were less robust.ConclusionsImpaired LV global longitudinal strain, lower LA reservoir strain and lower TAPSE/PASP ratio predict cardiovascular death and HF hospitalization in HFpEF and are independent of filling pressures, clinical characteristics and natriuretic peptides. These echocardiographic parameters reflect key functional changes in HFpEF, and should be incorporated in future prospective risk prediction models.

中文翻译：

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射血分数保留的心力衰竭心血管结局的超声心动图预测因子

目的 射血分数保留的心力衰竭 (HF) (HFpEF) 心血管结局的最佳超声心动图预测因子尚不清楚。我们的目的是确定 HFpEF 患者心血管结局的独立超声心动图预测因子。方法和结果从成立之日起至 2022 年 11 月对三个电子数据库进行了系统文献检索。超声心动图的风险比 (HR) 及其 95% 置信区间 (CI)使用随机效应荟萃分析汇总了心血管死亡和心力衰竭住院复合主要终点的多变量预测模型的变量。对纳入急性与慢性心力衰竭患者的研究以及包括 E/e'、肺动脉收缩压 (PASP)、肾功能、利钠肽和多变量模型中利尿剂使用的研究进行了特定的亚组分析。纳入了 46 项研究，总计 20056 名 HFpEF 患者。在所有亚组分析中，三个超声心动图参数成为独立的预测因素：左心室（LV）整体纵向应变减少（HR 1.24，每减少 5% 95% CI 1.10-1.39），左心房（LA）储存应变减少（HR 1.30，95）每减少 5%，% CI 1.13–1.1.50）和下三尖瓣环平面收缩期偏移 (TAPSE) 与 PASP 的比率（HR 1.17，每减少 0.1 单位，95% CI 1.07–1.25）。主要终点的其他独立超声心动图预测因素包括较高的 E/e'、中度至重度三尖瓣反流、左室质量指数和 LA 射血分数，尽管这些变量不太稳健。结论 左室整体纵向应变受损、LA 储存应变较低和 TAPSE 较低/PASP 比率可预测 HFpEF 中的心血管死亡和心力衰竭住院治疗，且与充盈压、临床特征和利尿钠肽无关。这些超声心动图参数反映了 HFpEF 的关键功能变化，应纳入未来的前瞻性风险预测模型。