Abstract
PURPOSE: This study aimed 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 analyzed 158 patients with heart failure with reduced ejection fraction [HFrEF; left ventricular ejection fraction (LVEF) < 40%] treated with the "new quadruple" therapy (angiotensin receptor neprilysin inhibitor (ARNI), sacubitril/valsartan, dapagliflozin, bisoprolol, and spironolactone) for 8 weeks. Conventional ultrasound indices, left ventricular global longitudinal strain (LVGLS), and subendocardial longitudinal strain (LS) were measured pre- and post-treatment. Follow-up for 15 months recorded major adverse cardiac events (MACEs). RESULTS: The 158 patients were 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 were 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, which was 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 quadruple" therapy in HFrEF patients with metabolic syndrome, highlighting substantial clinical applicability. Additionally, our findings suggest that the therapy may improve prognosis through the modulation of neuroendocrine mechanisms.