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Title: | Incremental value of left ventricular global longitudinal strain in moderate aortic stenosis and reduced left ventricular ejection fraction* | Authors: | STASSEN, Jan Singh, Gurpreet K. Pio, Stephan M. Chimed, Suren Butcher, Steele C. Hirasawa, Kensuke Marsan, Nina Ajmone Bax, Jeroen J. |
Issue Date: | 2023 | Publisher: | ELSEVIER IRELAND LTD | Source: | INTERNATIONAL JOURNAL OF CARDIOLOGY, 373 , p. 101 -106 | Abstract: | Background: Moderate aortic stenosis (AS) often coexists with left ventricular (LV) systolic dysfunction and may affect survival through afterload mismatch. Because outcomes are ultimately driven by the condition of the LV, accurate assessment of LV performance is crucial to improve risk stratification. This study investigated the prognostic value of LV global longitudinal strain (GLS) in patients with moderate AS and reduced LV systolic dysfunction. Methods: Patients with moderate AS (aortic valve area 1.0-1.5 cm2) and reduced LV ejection fraction (EF) (<50%) were identified. LVGLS was evaluated with speckle-tracking echocardiography. Patients were divided into 2 groups according to an LVGLS value of 11%, based on spline curve analysis. The primary endpoint was allcause mortality. Results: A total of 166 patients (mean age 73 +/- 11 years, 71% male) were included. The cumulative 1- and 5-year mortality rates were higher in patients with LVGLS <11% (25% and 60%) versus LVGLS >= 11% (10% and 27%) (p < 0.001). On multivariable analysis, LVGLS as a continuous variable (HR 0.753; 95% CI 0.673-0.843; p < 0.001) and as a categorical variable (<11%) (HR 3.028; 95% CI 1.623-5.648; p < 0.001) were independently associated with outcomes, whereas LVEF was not. LVGLS provided additional prognostic information in patients with/without coronary artery disease and with mildly versus severely reduced LVEF. In addition, LVGLS had incremental prognostic value over established risk factors, including LVEF. Conclusion: The combination of moderate AS and reduced LV systolic dysfunction is associated with a high mortality risk. LVGLS, but not LVEF, is independently associated with mortality and provides incremental prognostic value over established risk factors in patients with moderate AS and reduced LVEF. | Notes: | Bax, JJ (corresponding author), Heart Lung Ctr, Dept Cardiol, Albinusdreef 2, NL-2300 RC Leiden, Netherlands. j.j.bax@lumc.nl |
Keywords: | Moderate aortic stenosis;Left ventricular systolic dysfunction;Left ventricular global longitudinal strain;Left ventricular ejection fraction;Mortality | Document URI: | http://hdl.handle.net/1942/40121 | ISSN: | 0167-5273 | e-ISSN: | 1874-1754 | DOI: | 10.1016/j.ijcard.2022.11.035 | ISI #: | 000977882200001 | Rights: | 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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Incremental value of left ventricular global longitudinal strain in moderate aortic stenosis and reduced left ventricular ejection fraction.pdf | Published version | 1.05 MB | Adobe PDF | View/Open |
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