This study will compare two ultrasound techniques, 2D and 3D speckle-tracking echocardiography, for measuring how well the heart muscle contracts in patients with heart failure and reduced pumping function. While 2D global longitudinal strain (GLS) is widely used and has proven value in predicting outcomes, 3D GLS may provide a more complete assessment of heart function. Researchers will enroll 419 patients from seven cardiac rehabilitation hospitals in Italy and analyze heart ultrasound images using standardized equipment and software. The study will assess how closely 2D and 3D GLS measurements agree, identify factors that influence any differences, and determine whether 3D GLS better predicts the risk of death than 2D GLS.
Left ventricular ejection fraction (LVEF) ≤ 49%;
Echocardiographic image quality judged to be at least adequate according to a four-point visual image quality scale (good, adequate, poor, or inadequate)
Inability to maintain the correct position for acquiring echocardiographic images;
Arrhythmias that make multi-beat acquisition impossible (if required), such as frequent extrasystoles (supraventricular or ventricular) and atrial fibrillation;
Failure to visualize more than 2 segments of the left ventricle (LV), or inability to assess more than 3 segments during 3D GLS analysis;
Failure to sign the informed consent form and inability of the participant to understand the objectives of the study
Patients with a diagnosis of heart failure and a reduced or mildly reduced ejection fration of left ventricle
Cohort
Prospective
Not listed
Bland-Altman mean difference (bias) and the limits of agreement (LOA) in comparison with a clinically acceptable range (±6.5%)
Bias and the LOA will be compared with a clinically acceptable range (±6.5%)
Covariates and Confounders
The factors associated with differences between 2D and 3D GLS measurements
Comparison of all-cause mortality by 2D and 3D global longitudinal strain
The area under the receiver operating characteristic curve (AUC-ROC) will be used to assess the predictive performance of 2D and 3D GLS for all-cause mortality. The DeLong test will be used to compare the AUCs of the two methods.
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