Abstract
Background
Management of patients with asymptomatic severe aortic stenosis (AS) and preserved left ventricular (LV) ejection fraction (EF) remains controversial. Recent studies have shown prognostic value of decreased LV global longitudinal strain in AS patients with preserved LVEF. Tissue-tracking mitral annular displacement (TMAD) in single apical four-chamber view (AP4) by speckle-tracking echocardiography provides automated rapid assessment of LV longitudinal deformation (Figure). This simple method may be useful for the prediction of cardiac events in asymptomatic severe AS patients with preserved LVEF.
Purpose
The purpose of this study was to examine the value of TMAD to predict cardiac events in asymptomatic severe AS patients with preserved LVEF.
Methods
The study population consisted of 103 patients with severe AS and preserved LVEF [aortic velocity >4m/s or aortic valve area (AVA) <1.0 cm², LVEF >50%]. After exclusion of 56 patients who met the exclusion criteria (symptomatic, atrial fibrillation, significant mitral valve diseases, history of cardiac surgery, short follow-up period <120 days, and inadequate echocardiographic images), the final study population consisted of 47 patients. Using TMAD analysis software (QLAB 10.5, Philips), the base-to-apex displacement of automatically defined mid-point of mitral annular line in AP4 was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated . We investigated the occurrence of the cardiac events including appearance of symptoms, decreased LVEF (< 50%), and cardiac death.
Results
%TMAD was successfully and quickly evaluated in 44 (94%) of 47 patients. During a follow-up, the cardiac events developed in 16 (36%) of 44 patients. %TMAD was significantly impaired in patients with the cardiac events compared with those without the cardiac events (9.6 ± 1.9 vs 12.1 ± 2.6%, p= 0.002). There were no significant differences in the other parameters including age, LVEF, aortic velocity, AVA, tricuspid regurgitation pressure gradient, early diastolic /atrial filling velocity (E/A), early diastolic velocity of the mitral valve annulus (e’) and E/e’ between the patients with and without the cardiac events. Receiver operating characteristic analysis revealed that area under the curve of %TMAD was 0.81 for the cardiac events. Kaplan-Meier analysis showed %TMAD (cut-off: 11.9) provides a significant difference in the cardiac events (hazard ratio 14.8, 95% CI, 2.75-79.3; p= 0.002).
Conclusions
The present results suggest that automated TMAD measurement by speckle-tracking echocardiography may be useful to predict cardiac events in asymptomatic severe AS patients with preserved LVEF.
Abstract P313 Figure
Prognostic Value of LV Deformation Parameters Using 2D and 3D Speckle-Tracking Echocardiography in Asymptomatic Patients With Severe Aortic Stenosis and Preserved LV Ejection Fraction