Longitudinal Evolution of Cardiac Dysfunction in Heart Failure and Preserved Ejection Fraction With Normal Natriuretic Peptide Levels

We compared longitudinal changes in cardiac function assessed by 2D speckle tracking in patients with HFpEF stratified by natriuretic peptide (NP) levels and healthy controls. LVGLS, LA reservoir strain, and RVFWS were higher in normal NP-HFpEF than high NP-HFpEF at index evaluation, indicating better myocardial function. LA reservoir strain was lower in normal NP-HFpEF than controls, but there were no significant differences in LVGLS or RVFWS at baseline. Over 3.1 years of follow up, LVGLS, LA reservoir strain and RVFWS deteriorated in patients with HFpEF, with no difference in the rate of change in patients with normal or high NP levels. In contrast, there was no change in biventricular or LA function in controls over the same interval. These data suggest that HFpEF with normal NP represents an earlier stage of HFpEF, rather than a fundamentally different phenotype.