Trial reportEuropean journal of heart failure2017
Impaired left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction: insights from the RELAX trial.
Trial report in European journal of heart failure, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 92 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
92 citing papers in PubMed, 1 synthesis or guideline pooled it, 180 citations in OpenAlex.
- Highlights in heart failure.ESC heart failure · 2019Pooled it
- On the search for the right definition of heart failure with preserved ejection fraction.Cardiology journal · 2020Trial
- Strain imaging in heart failure: from early detection to prognostic assessment.ESC heart failure · 2026Review
- Assessment of agreement of left ventricular myocardial strain derived from cardiac computed tomography with cardiac magnetic resonance.The international journal of cardiovascular imaging · 2026Article
- Four-Chamber Deformation Remodeling and Atrial Fibrillation After Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy.Echocardiography (Mount Kisco, N.Y.) · 2026Article
- Heart Failure with Preserved Ejection Fraction in Women: Sex-Specific Insights Across the Continuum from Diagnosis to Outcomes.Current cardiology reports · 2026Review
- Left Atrial Reservoir Strain Combined With Left Ventricular Longitudinal Strain Improves Discrimination of HFpEF in Patients With Hypertension.Journal of clinical hypertension (Greenwich, Conn.) · 2026Article
- Left Ventricular Ejection Fraction in Heart Failure-A Parameter to Be Discontinued?Journal of clinical medicine · 2026Review
- Cardiorenal Interactions in Acute Decompensated Heart Failure: Associations Between Renal Dysfunction, Albuminuria, and Echocardiographic Markers of Myocardial Function.Life (Basel, Switzerland) · 2026Article
- Myocardial strain shows modest diagnostic yield but may aid identification of patients with a low likelihood of ischemia during vasodilator stress cardiac magnetic resonance.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Clinical and prognostic impact of left atrial strain in non-ischemic cardiomyopathies.The international journal of cardiovascular imaging · 2026Review
- Heart Failure with Preserved Ejection Fraction (HFpEF), Pulse Wave Velocity, and Heart Rate Recovery Interconnections-A Brief Literature Review.Journal of clinical medicine · 2025Review
- Feasibility, accuracy and prognostic value of fully automated speckle tracking analysis-derived left ventricular ejection fraction and global longitudinal strain.Scientific reports · 2025Article
- Low-flow in aortic valve stenosis patients with reduced ejection fraction does not depend on left ventricular function.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Article
- Heart failure with preserved ejection fraction in cancer patients and survivors. A scientific statement of the Heart Failure Association of the ESC and the ESC Council of Cardio-Oncology.European journal of heart failure · 2025Article
- Clinical Applications of Speckle-Tracking Echocardiography in Heart Failure: From Diagnosis to Prognostication.International journal of heart failure · 2025Review
- What Is Cardiometabolic HFpEF and How Can We Study it Preclinically?JACC. Basic to translational science · 2025Review
- Proarrhythmogenic Echocardiographic Markers in Metabolic Syndrome: A Cross-Sectional Study.Life (Basel, Switzerland) · 2025Article
- Article
- Prognostic impacts of left ventricular strain in hemodialytic patients with preserved left ventricular systolic function.Scientific reports · 2025Article
32 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
13 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundWhile abnormal left ventricular (LV) global longitudinal strain (GLS) has been described in patients with heart failure with preserved ejection fraction (HFpEF), its prevalence and clinical significance are poorly understood. METHODS AND
resultsPatients enrolled in the RELAX trial of sildenafil in HFpEF (LV ejection fraction ≥50%) in whom two-dimensional, speckle-tracking LV GLS was possible (n = 187) were analysed. The distribution of LV GLS and its associations with clinical characteristics, LV structure and function, biomarkers, exercise capacity and quality of life were assessed. Baseline median LV GLS was -14.6% (25th and 75th percentile, -17.0% and -11.9%, respectively) and abnormal (≥ - 16%) in 122/187 (65%) patients. Patients in the tertile with the best LV GLS had lower N-terminal pro-brain natriuretic peptide (NT-proBNP) [median 505 pg/mL (161, 1065) vs. 875 pg/mL (488, 1802), P = 0.008) and lower collagen III N-terminal propeptide (PIIINP) levels [median 6.7 µg/L (5.1, 8.1) vs. 8.1 µg/L (6.5, 10.5), P = 0.001] compared with the tertile with the worst LV GLS. There was also a modest linear relationship with LV GLS and log-transformed NT-proBNP and PIIINP (r = 0.29, P < 0.001 and r = 0.19, P = 0.009, respectively). We observed no linear association of LV GLS with Minnesota Living with Heart Failure scores, 6-min walk distance, peak oxygen consumption, or expiratory minute ventilation/carbon dioxide excretion slope.
conclusionsImpaired LV GLS is common among HFpEF patients, indicating the presence of covert systolic dysfunction despite normal LV ejection fraction. Impaired LV GLS was associated with biomarkers of wall stress and collagen synthesis and diastolic dysfunction but not with quality of life or exercise capacity, suggesting other processes may be more responsible for these aspects of the HFpEF syndrome.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.