Prognostic implications of left ventricular global longitudinal strain in patients with bicuspid aortic valve disease and preserved left ventricular ejection fraction

2019 ◽  
Vol 21 (7) ◽  
pp. 759-767 ◽  
Author(s):  
William K F Kong ◽  
E Mara Vollema ◽  
Francesca Prevedello ◽  
Rebecca Perry ◽  
Arnold C T Ng ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Increased Risk ◽  
Prognostic Implications ◽  
Lv Systolic Function

Abstract Aims In patients with bicuspid aortic valve (BAV) and preserved left ventricular (LV) ejection fraction (EF), the frequency of impaired LV global longitudinal strain (GLS) and its prognostic implications are unknown. The present study evaluated the proportion and prognostic value of impaired LV GLS in patients with BAV and preserved LVEF. Methods and results Five hundred and thirteen patients (68% men; mean age 44 ± 18 years) with BAV and preserved LVEF (>50%) were divided into five groups according to the type of BAV dysfunction: (i) normal function BAV, (ii) mild aortic stenosis (AS) or aortic regurgitation (AR), (iii) ≥moderate isolated AS, (iv) ≥moderate isolated AR, and (v) ≥moderate mixed AS and AR. LV systolic dysfunction based on 2D speckle-tracking echocardiography was defined as a cut-off value of LVGLS (−13.6%). The primary outcome was aortic valve intervention or all-cause mortality. The proportion of patients with LVGLS ≤−13.6% was the highest in the normal BAV group (97%) and the lowest in the group with moderate and severe mixed AS and AR (79%). During a median follow-up of 10 years, 210 (41%) patients underwent aortic valve replacement and 17 (3%) died. Patients with preserved LV systolic function (LVGLS ≤ −13.6%) had significantly better event-free survival compared to those with impaired LV systolic function (LVGLS > −13.6%). LVGLS was independently associated with increased risk of events (mainly aortic valve replacement): hazard ratio 1.09; P < 0.001. Conclusion Impaired LVGLS in BAV with preserved LVEF is not infrequent and was independently associated with increased risk of events (mainly aortic valve replacement events).

Left Ventricular Function Assessment by Strain Analysis in Patients with Severe Aortic Stenosis with Preserved Ejection Fraction Undergoing Aortic Valve Replacement – A Prospective Longitudinal Study at a Tertiary Health Care Centre of South India

2021 ◽  
Vol 8 (27) ◽  
pp. 2405-2411
Author(s):  
Syed Waleem Pasha ◽  
Narasimha D. Pai ◽  
Padmanabha Kamath ◽  
Ramanatha L. Kamath ◽  
Francis N.P. Monteiro
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Strain Rate ◽  
Valve Replacement ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Study Population

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

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

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%.

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

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 %.

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

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 %.

P3377MDCT-derived left ventricular global longitudinal strain and left ventricular ejection fraction in patients with aortic stenosis: a comparative analysis with echocardiographic measurements

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Gegenava ◽  
P Bijl ◽  
M Vollema ◽  
F Kley ◽  
A Weger ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Longitudinal Strain ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Mean Value ◽  
Left Ventricular ◽  
Altman Analysis ◽  
Limits Of Agreement ◽  
Bland Altman Analysis ◽  
Lv Systolic Function

Abstract Introduction Known predictors of poor outcome in aortic valve stenosis patients include older age, significant valvular calcification, rapid hemodynamic progression and impaired left ventricular (LV) systolic function. LV global longitudinal strain (GLS) quantifies myocardial deformation and LV function and is associated with prognosis in patients with severe aortic stenosis (AS). Multi-detector row computed tomography (MDCT) data are key in the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI) and when acquired throughout the entire cardiac cycle, LV systolic function can be assessed. Novel software can assess LV GLS from MDCT-data. Purpose The present study aimed at assessing the feasibility of determining novel MDCT-derived LV GLS as well as MDCT-derived LV ejection fraction (EF) and their agreement with echocardiographic LV GLS and LVEF in patients treated with TAVI. Methods LVEF and LV GLS were measured on echocardiography and dynamic MDCT using novel CT-software. Agreement between the measurements of two different modalities was assessed using Bland-Altman analysis. Results A total 214 patients (51% male, mean age: 80±7 years) were analysed retrospectively. Mean value of LV GLS on echocardiography was −14±4% whereas mean MDCT-derived GLS was −12.5±4%. Mean value of LVEF on echocardiography was 47±10% and mean MDCT-derived LVEF was 39±11%. On Bland-Altman analysis, MDCT-derived strain analysis underestimated LV GLS compared to echocardiography with a mean difference of 1.44% (95% limits of agreement −3.8 to 6.7%). LVEF was also underestimated on CT with a mean difference of 7.68% (95% limits of agreement −11.5% to −26%). Correlation of measurements between MDCT-derived LV GLS and echocardiographic LV GLS was significant (r=0.791, p<0.001), as well as the correlation between MDCT-derived LVEF and echocardiographic LVEF (r=0.590, p<0.001) (Figure). Conclusions Assessment of LV GLS and LVEF on dynamic MDCT data provides similar values to those obtained with echocardiography and could be used in the risk-stratification of severe AS patients undergoing TAVI.

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