What symptoms might a 67-year-old woman with left ventricular dysfunction (GLS of -16.2%) experience?

Symptoms in a 67-Year-Old Woman with Left Ventricular Dysfunction (GLS -16.2%)

A 67-year-old woman with a GLS of -16.2% is likely to experience dyspnea on exertion, fatigue, and reduced exercise tolerance, as this degree of impaired global longitudinal strain indicates subclinical left ventricular systolic dysfunction that significantly impacts functional capacity and quality of life, even when ejection fraction appears preserved.

Primary Symptom Profile

Exertional Symptoms

• Dyspnea on exertion is the most common presenting symptom in patients with impaired GLS, particularly in this age group 1
• Fatigue and reduced exercise capacity are prominent features, with studies showing that abnormal GLS (>-15.8%) is associated with significantly decreased 6-minute walk distance 2
• Chest discomfort may occur intermittently, particularly during physical activity, related to increased LV filling pressures and potential myocardial ischemia from supply-demand mismatch 1

Cardiac-Related Symptoms

• Palpitations may be present, as abnormal GLS (>-14.7%) is independently associated with a 3.2-fold increased risk of developing atrial fibrillation 3
• Leg swelling can occur due to elevated LV filling pressures and diastolic dysfunction that commonly accompanies impaired longitudinal strain 1

Clinical Context and Risk Factors

Age and Gender Considerations

• At 67 years, this patient falls into the high-risk category for left ventricular diastolic dysfunction, which is strongly associated with age >65 years 1
• Women with small LV size commonly present with preserved ejection fraction but impaired GLS, representing a phenotype of heart failure with preserved ejection fraction (HFpEF) 1

Functional Implications

• A GLS of -16.2% indicates subclinical LV systolic dysfunction that precedes reduction in ejection fraction 1
• This level of impairment is associated with elevated LV filling pressures (E/e' ratio typically >14) and increased left atrial volume 1, 4
• The patient likely has WHO functional class II-III symptoms, meaning normal daily activities are affected or troubling 1

Associated Comorbidities to Consider

Common Coexisting Conditions

• Hypertension is frequently present and contributes to concentric LV remodeling and diastolic dysfunction 1
• Metabolic syndrome or diabetes may coexist, as these conditions are associated with worse GLS values (-17.7% in diabetics vs -19.0% in non-diabetics) and reduced functional capacity 2
• Atrial fibrillation should be suspected if palpitations are present, given the strong association with abnormal GLS 3

Prognostic Implications

Risk Stratification

• GLS of -16.2% predicts adverse outcomes: Each 1% worsening in GLS is associated with 10% increased odds for cardiovascular mortality or heart failure hospitalization 4
• This patient has a significantly elevated risk (approximately 60% over 4-5 years) of experiencing the composite outcome of cardiovascular death or HF hospitalization compared to those with normal GLS 4
• There is a 2.2-fold increased risk of deterioration in LVEF to <40% over time 4

Symptom Progression

• Worsening dyspnea over months is typical, particularly if GLS continues to deteriorate (≥15% decline indicates significant progression) 5
• Symptoms may be exacerbated postprandially or with alcohol intake due to dynamic changes in loading conditions 1

Clinical Pitfalls

• Normal ejection fraction does not exclude significant cardiac dysfunction: GLS detects myocardial impairment when EF remains preserved 1
• Symptoms may be attributed to other causes (pulmonary disease, deconditioning) when in fact they reflect cardiac limitation—exercise testing with hemodynamic assessment can clarify 1
• Asymptomatic periods can occur even with significant cardiac dysfunction, but this does not reduce risk of adverse outcomes 1, 4