Left ventricular global longitudinal strain is predictive of all-cause mortality independent of aortic stenosis severity and ejection fraction

BACKGROUND Aortic stenosis (AS) is the most common, single, native valvular heart disease in adult population. The purpose of this study was to detect abnormalities in global longitudinal strain (GLS) and strain rate using 2D - STI in patients with severe AS and preserved left ventricular ejection fraction (LVEF). The effect of aortic valve replacement (AVR) on changes in strain parameters 30 days after surgery was also analysed. METHODS A total number of 60 patients aged more than 18 years with aortic valve disease scheduled for surgical aortic valve replacement admitted in Department of Cardiology, KMC hospital Mangalore, were included over a period of 18 months from January 2017 to June 2018. RESULTS A total of 60 patients with severe AS, defined by an aortic valve area of < 1 cm², mean transaortic pressure gradient ( P) of > 40 mmHg and maximum aortic velocity (Vmax) of > 4 m/sec were studied. Mean age of the study population was 63.5 years. 60 % of the population were males and 40 % being females. Most common risk factor present in the study population was diabetes mellitus (DM). 83% of the patients in the study population had at least one symptom. Most common symptom with which the patients presented was exertional dyspnoea. All patients had normal left ventricle (LV) cavity dimensions and LVEF prior to surgery with diastolic dysfunction being present in all patients. The LV ejection fraction is not significantly altered. The aortic valve area calculated by continuity equation has significantly increased post AVR with a significant reduction in transaortic peak and means pressure gradients. Mean global longitudinal strain (GLS) improved from -15.1 % to - 16.9 % (P < 0.001) and longitudinal strain rate improved from -0.8 to -0.9/s (P < 0.001). CONCLUSIONS Global longitudinal strain and strain rate can be adequately measured by 2D speckle-tracking imaging and can be used to detect subtle changes of myocardial function in patients with severe AS with preserved LVEF. KEYWORDS Aortic Stenosis, Exertional Dyspnoea, Global Longitudinal Strain, Transaortic Pressure Gradient, Ventricular Hypertrophy

Download Full-text

Segmentally impaired left ventricular longitudinal strain: a new predictive diagnostic parameter for asymptomatic patients with severe aortic stenosis and preserved ejection fraction

Perfusion ◽

10.1177/0267659121995998 ◽

2021 ◽

pp. 026765912199599

Author(s):

Peggy M Kostakou ◽

Elsie S Tryfou ◽

Vassilios S Kostopoulos ◽

Lambros I Markos ◽

Dimitrios S Damaskos ◽

...

Keyword(s):

Left Ventricle ◽

Aortic Stenosis ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Severe Aortic Stenosis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Average Strain ◽

Asymptomatic Patients ◽

Significant Difference

Introduction: This study aims to investigate the correlation between severe aortic stenosis (sAS) and impairment of left ventricular global longitudinal strain (LVGLS) in particular segments, using two-dimensional speckle tracking echocardiography in patients with sAS and normal ejection fraction of left ventricle (LVEF). Methods: The study included 53 consecutive patients with asymptomatic sAS and preserved LVEF. The regional longitudinal systolic LV wall strain was evaluated at the area opposite of the aorta as the median strain value of the basal, middle, and apical segments of the lateral and posterior walls and was compared to the average strain value of the interventricular septum (IVS) at the same views. Results: LVGLS was decreased and was not statistically different between three- and four-chamber views (−12.5 ± 3.6 vs −11.4 ± 5.5%, p = 0.2). The average strain values of the lateral and posterior walls were statistically reduced compared to the average value of the IVS (lateral vs IVS: −7.8 ± 3.7 vs −10 ± 5.3%, p = 0.005, posterior vs IVS: −7.7 ± 4.2 vs −10.3 ± 3.8%, p < 0.0001). There was no significant difference between lateral and posterior walls (−7.8 ± 3.7 vs −7.7 ± 4.2%, p = 0.9). Conclusions: The strain of lateral and posterior walls of left ventricle, which lay just opposite to the aortic valve seem to be more reduced compared to other walls in patients with sAS and preserved LVEF possibly due to their anatomical position. This impairment seems to be the reason of the overall LVGLS reduction. Regional strain could be used as an extra tool for the estimation of the severity of AS as well as for prognostic information in asymptomatic patients.

Download Full-text

Distribution and prognostic value of left ventricular global longitudinal strain in elderly patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01791-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jonas Agerlund Povlsen ◽

Vibeke Guldbrand Rasmussen ◽

Henrik Vase ◽

Kaare Troels Jensen ◽

Christian Juhl Terkelsen ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Elderly Patients ◽

Valve Replacement ◽

Prognostic Value ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

All Cause Mortality

Abstract Aims The aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival. Methods We included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available. Results Mean age was 80.1 ± 7.1 years and aortic valve area (AVA) index 0.4 ± 0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50 ± 13% and mean LVGLS was − 14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS > − 18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS > − 14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient > 30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS > − 14% (HR 1.79 [1.02–3.14], p = 0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS > − 14% in the total population (p < 0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p = 0.006). Conclusions In patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS > − 14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS > − 14%.

Download Full-text

VALVULOARTERIAL IMPEDANCE AND LEFT VENTRICULAR GLOBAL LONGITUDINAL STRAIN PROVIDE INCREMENTAL PROGNOSTIC VALUE IN PATIENTS WITH SIGNIFICANT AORTIC STENOSIS AND PRESERVED LEFT VENTRICULAR EJECTION FRACTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)35322-6 ◽

2017 ◽

Vol 69 (11) ◽

pp. 1933

Author(s):

Chetan Huded ◽

Andrew Goodman ◽

Kenya Kusunose ◽

Lars Svensson ◽

A. Gillinov ◽

...

Keyword(s):

Left Ventricular Ejection Fraction ◽

Aortic Stenosis ◽

Ejection Fraction ◽

Prognostic Value ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Incremental Prognostic Value

Download Full-text

Distribution and Prognostic Value of Left Ventricular Global Longitudinal Strain in Elderly Patients with Symptomatic Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

10.21203/rs.3.rs-42899/v1 ◽

2020 ◽

Author(s):

Jonas Agerlund Povlsen ◽

Vibeke Guldbrand Rasmussen ◽

Henrik Vase ◽

Kaare Troels Jensen ◽

Christian Juhl Terkelsen ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Elderly Patients ◽

Valve Replacement ◽

Prognostic Value ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

All Cause Mortality

Abstract Aims The aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival.Methods We included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available. Results Mean age was 80.1±7.1 years and aortic valve area (AVA) index 0.4±0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50±13% and mean LVGLS was -14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS >-18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS >-14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient >30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS >-14% (HR 1.79 [1.02-3.14], p=0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS >-14% in the total population (p<0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p=0.006).Conclusions In patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS >-14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS >-14 %.

Download Full-text

Distribution and Prognostic Value of Left Ventricular Global Longitudinal Strain in Elderly Patients with Symptomatic Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

10.21203/rs.3.rs-42899/v2 ◽

2020 ◽

Author(s):

Jonas Agerlund Povlsen ◽

Vibeke Guldbrand Rasmussen ◽

Henrik Vase ◽

Kaare Troels Jensen ◽

Christian Juhl Terkelsen ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Elderly Patients ◽

Valve Replacement ◽

Prognostic Value ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

All Cause Mortality

Abstract AimsThe aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival.MethodsWe included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available.ResultsMean age was 80.1±7.1 years and aortic valve area (AVA) index 0.4±0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50±13% and mean LVGLS was -14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS >-18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS >-14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient >30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS >-14% (HR 1.79 [1.02-3.14], p=0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS >-14% in the total population (p<0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p=0.006).ConclusionsIn patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS >-14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS >-14 %.

Download Full-text

Abstract 14578: A Meta-analysis of Global Longitudinal Strain as a Predictor of Major Adverse Cardiac Events in Severe, Asymptomatic Aortic Stenosis With Preserved Ejection Fraction

Circulation ◽

10.1161/circ.132.suppl_3.14578 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Stefanie Furlan ◽

Leonardo Tamariz ◽

Robert Chait

Keyword(s):

Aortic Stenosis ◽

Ejection Fraction ◽

Longitudinal Strain ◽

Meta Analysis ◽

Global Longitudinal Strain ◽

Case Control ◽

Left Ventricular ◽

Cardiac Events ◽

Case Control Studies ◽

Reported Data

Introduction: The timing of surgical intervention in aortic stenosis (AS) is critical. Guidelines recommend aortic valve replacement in severe, asymptomatic AS with an ejection fraction (EF) less than 50%. Two-dimensional speckle tracking echocardiography is a relatively novel way to identify left ventricular dysfunction by measuring myocardial strain. Global longitudinal strain (GLS) is a measurement of deformation of the myocardium, and is considered a more sensitive marker for left ventricular dysfunction than EF. Hypothesis: Our aim was to determine if abnormal GLS predicts poor outcomes in severe, asymptomatic AS patients with a preserved EF. Methods: We conducted a meta-analysis and searched MEDLINE, EMBASE, Cochrane (2000 to 2015), supplemented by manual bibliographies of key relevant articles. We selected all cohort, cross-sectional, and case-control studies in which GLS was measured and major adverse cardiac events (MACE) were reported. In the case-control studies, we calculated the pooled standard mean difference (SMD) of GLS between those with MACE and those without MACE. In cohort studies, we calculated the pooled relative risk (RR) with the corresponding 95% confidence interval (CI) for incident MACE by using the fixed effects method. Results: Our search strategy identified 3 studies that met the inclusion criteria, and included 370 AS patients. Of the 3 studies, all reported data using a case-control design and 2 reported data using a cohort design. The median age of AS patients included was 72.6 years old, the median indexed aortic valve area was 0.44 (cm 2 /m 2 ), and the median ejection fraction was 64.2 (%). Of the 370 patients included in the analysis, 183 had MACE. Case-control studies revealed a pooled GLS SMD of 0.5 (95% CI: 0.30-0.69, p<0.01) for patients with MACE compared to those without MACE. Cohort studies revealed a RR of MACE of 2.07 (95% CI: 1.59-2.69, p<0.01) for those with abnormal GLS compared to those normal GLS. Conclusions: AS patients with a more positive global longitudinal strain value were more likely to have a major adverse cardiac event despite having a preserved EF and absence of symptoms. Therefore, if abnormal GLS is detected, earlier surgical intervention should be considered in severe, asymptomatic aortic stenosis.

Download Full-text

Incremental value of left ventricular global longitudinal strain in a newly proposed staging classification based on cardiac damage in patients with severe aortic stenosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa220 ◽

2020 ◽

Vol 21 (11) ◽

pp. 1248-1258 ◽

Cited By ~ 1

Author(s):

E Mara Vollema ◽

Mohammed R Amanullah ◽

Edgard A Prihadi ◽

Arnold C T Ng ◽

Pieter van der Bijl ◽

...

Keyword(s):

Aortic Stenosis ◽

Prognostic Value ◽

Longitudinal Strain ◽

Severe Aortic Stenosis ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Cardiac Damage ◽

All Cause Mortality ◽

Incremental Prognostic Value ◽

Staging Classification

Abstract Aims Cardiac damage in severe aortic stenosis (AS) can be classified according to a recently proposed staging classification. The present study investigated the incremental prognostic value of left ventricular (LV) global longitudinal strain (GLS) over stages of cardiac damage in patients with severe AS. Methods and results From an ongoing registry, a total of 616 severe symptomatic AS patients with available LV GLS by speckle tracking echocardiography were selected and retrospectively analysed. Patients were categorized according to cardiac damage on echocardiography: Stage 0 (no damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). LV GLS was divided by quintiles and assigned to the different stages. The endpoint was all-cause mortality. Over a median follow-up of 44 [24–89] months, 234 (38%) patients died. LV GLS was associated with all-cause mortality independent of stage of cardiac damage. After incorporation of LV GLS by quintiles into the staging classification, Stages 2–4 were independently associated with outcome. LV GLS showed incremental prognostic value over clinical characteristics and stages of cardiac damage. Conclusion In this large single-centre cohort of severe AS patients, incorporation of LV GLS by quintiles in a novel proposed staging classification resulted in refinement of risk stratification by identifying patients with more advanced cardiac damage. LV GLS was shown to provide incremental prognostic value over the originally proposed staging classification.

Download Full-text