Ultrasound Speckle Tracking Imaging Measurement of Endocardial Longitudinal Strain for Evaluation of Prognostic Value of “New Quadruple” Therapy in Patients with Chronic Heart Failure

Man Tang ^1* Yuwei Zeng ¹ Ping Zhao ¹ Qianlei Zhao ²

• ¹ Department of Ultrasound, The Affiliated People's Hospital of Ningbo University, Ningbo 315000, Zhejiang, China, Ningbo, China
• ² Department of Cardiology, The Affiliated People's Hospital of Ningbo University, Ningbo 315000, Zhejiang, China, Ningbo, China

Purpose: This study aims to evaluate the effectiveness of the “New Quadruple” Therapy in chronic heart failure (CHF) patients with metabolic syndrome using 2D Speckle Tracking Imaging (2D-STI) stratified strain imaging to measure endocardial longitudinal strain, while exploring its underlying neuroendocrine mechanisms.Patients and Methods: The study retrospectively analyzes 158 heart failure with reduced ejection fraction (HFrEF) patients (left ventricular ejection fraction (LVEF) < 40%) treated with the 'New Quadruple' Therapy (angiotensin receptor neprilysin inhibitor (ARNI), Sacubitril/Valsartan, Dapagliflozin, bisoprolol, spironolactone) for 8 weeks. Conventional ultrasound indices, left ventricular global longitudinal strain (LVGLS), and subendocardial longitudinal strain (LS) are measured pre- and post-treatment. Follow-up for 15 months recorded major adverse cardiac events (MACEs).Results: The 158 patients are divided into two groups: MACEs (n=25) and no MACEs (n=133). Univariate comparisons revealed significant differences between groups in coronary artery diameter stenosis percentage, admission LVEF and brain natriuretic peptide (BNP), LVGLS and subendocardial LS, post-treatment LVEF, LVGLS, and subendocardial LS, ΔLVGLS, and subendocardial ΔLS (P < 0.05). Multifactorial Cox regression modeling showed that coronary artery diameter stenosis, admission LVEF, BNP, subendocardial LS, post-treatment LVEF, and subendocardial LS are predictive factors for MACEs in HFrEF patients following “New Quadruple” Therapy (P < 0.05). ROC analysis indicates that post-treatment subendocardial LS predicts MACEs with an AUC of 0.871, significantly higher than other single metrics (P < 0.05).Conclusions: Using 2D-STI layer-specific strain imaging to measure endocardial longitudinal strain serves as a significant non-invasive indicator in predicting MACEs during 1-year follow-up after “New Quad” Therapy in HFrEF patients with metabolic syndrome, highlighting substantial clinical applicability. Additionally, our findings suggest that the therapy may improve prognosis through modulating neuroendocrine mechanisms.