Reduced basal longitudinal strain (13.4% vs 15.7%) independently predicted future aortic valve replacement in asymptomatic patients with aortic stenosis over a median 2.3 years.
Cohort (n=104)
Does basal longitudinal strain predict the need for future aortic valve replacement or sudden cardiac death in asymptomatic patients with moderate-severe aortic stenosis?
Basal longitudinal strain is a significant independent predictor of future aortic valve replacement in asymptomatic patients with moderate-severe aortic stenosis, outperforming global longitudinal strain.
AIMS: To evaluate the prognostic value of global longitudinal strain (GLS) and basal longitudinal strain (BLS) with the knowledge of coexisting coronary pathology evaluated by multi-detector computed tomography (MDCT) coronary angiography. BACKGROUND: GLS and BLS are both sensitive markers of myocardial dysfunction and predictors of outcome in asymptomatic aortic stenosis. Aortic stenosis and ischaemic heart disease share risk factors and longitudinal function can be severely reduced in both conditions, why some of the previous findings of impaired regional longitudinal function in asymptomatic aortic stenosis could in fact be explained by silent ischaemic heart disease. METHODS AND RESULTS: Prospective follow-up of 104 asymptomatic patients with moderate-severe aortic stenosis defined as an aortic valve area <1.5 cm(2). Patients underwent a thorough clinical work-up, advanced echocardiographic analysis and coronary angiography by MDCT. The combined endpoint was indication for aortic valve replacement (AVR) and sudden cardiac death. During a median follow-up of 2.3 years (interquartile range 1.7-3.6) 43 patients (41%) met the endpoint of indication for AVR. The basal (13.4 ± 3.1% vs. 15.7 ± 3.1%) and mid-ventricular segments (14.9 ± 2.7% vs. 16.2 ± 2.9%) were significantly reduced, but with sparing of the apical segments, in patients who later underwent AVR. In various multivariable Cox regression models, including only BLS, but not GLS, remained an independent predictor of AVR. CONCLUSION: In contrast to GLS, reduced BLS is a significant predictor of future AVR in asymptomatic patients with aortic stenosis, independently of clinical characteristics, conventional echocardiographic measures, and coronary pathology.
Carstensen et al. (Sun,) conducted a cohort in Asymptomatic aortic stenosis (n=104). Basal longitudinal strain (BLS) vs. Global longitudinal strain (GLS) was evaluated on Indication for aortic valve replacement (AVR) and sudden cardiac death. Reduced basal longitudinal strain (13.4% vs 15.7%) independently predicted future aortic valve replacement in asymptomatic patients with aortic stenosis over a median 2.3 years.