Left Ventricular Mechanical Dispersion and Its Value in Combination With Global Longitudinal Strain to Predict Reverse Remodeling in Patients With Heart Failure With Reduced Ejection Fraction

Background: Left ventricular mechanical dispersion (LV-MD), an indicator of LV dyssynchrony, is not well studied in heart failure with reduced ejection fraction (HFrEF). This study aims to investigate the profile of LV-MD in HFrEF, and evaluate whether it provides predictive information in terms of LV reverse remodeling (LVRR), particularly, on top of LV global longitudinal strain (LV-GLS). Methods: In this observational cohort study, 239 consecutive patients hospitalized for HFrEF from 2020 to 2022 were included, and baseline and follow-up echocardiographic studies were performed. By strain analysis, LV-MD was calculated as the SD of time to peak negative longitudinal strain from 17 LV segments. LVRR was defined as an increase in LVEF of >= 10% and a decrease in LV end-diastolic diameter index of >= 10% or <= 33 mm/m(2). Results: During a median follow-up of 19 months, LVRR occurred in 152 patients (64%). A great heterogeneity of LV-MD ranging from 30 to 202 milliseconds was present in the cohort and 94 (84%) in 112 patients who were with LV-MD >76 milliseconds had no left bundle-branch block. LV-MD <= 76 milliseconds independently predicted LVRR and possessed greater discriminatory ability than LV-GLS by receiver operating characteristics analysis. Moreover, addition of LV-MD <= 76 milliseconds and LV-GLS <=-5.5% to a multivariable model, including age, HF duration, systolic blood pressure, QRS duration and use of angiotensin receptor-neprilysin inhibitors, improved predictive performance in terms of LVRR. Conclusions: LV mechanical dyssynchrony is widely present in HFrEF, irrespective of left bundle-branch block. LV-MD is significantly associated with LVRR, independent of and superior to LV-GLS. Combined assessments of LV-MD and LV-GLS provide additive value beyond clinical variables for predicting LVRR in HFrEF.