Key result
Reduced preoperative GLS linked to ~245% higher odds of insignificant LV mass regression in aortic PPM.
Why the study?
Aortic prosthesis-patient mismatch increases LV afterload and prevents LV mass regression, prompting investigation into whether baseline GLS associates with postoperative LV mass regression and adverse outcomes.
Does preoperative global longitudinal strain predict left ventricular mass regression and adverse outcomes in patients with aortic prosthesis-patient mismatch?
Cohort (n=256)
Does preoperative global longitudinal strain predict left ventricular mass regression and adverse outcomes in patients with aortic prosthesis-patient mismatch?
Answers are grounded in this paper and cite their sources.
Reduced preoperative global longitudinal strain is a sensitive predictor for limited left ventricular mass regression and is associated with an increased risk of adverse events in patients with aortic prosthesis-patient mismatch.
AIMS: Aortic prosthesis-patient mismatch (PPM) increases left ventricular (LV) afterload and prevents LV mass regression (LVMR) after surgery. This study was designed to investigate the association between the baseline global longitudinal strain (GLS) and the postoperative LVMR, and its relation to adverse outcomes. METHODS: A total of 316 patients with aortic stenosis undergoing isolated mechanical prosthesis implantation were screened, and data from 91 patients with aortic PPM and 165 non-PPM patients were retrospectively collected. All 256 patients underwent measurement of GLS by two-dimensional speckle-tracking echocardiography preoperatively, and were followed up for postoperative changes of LV mass index (LVMi) and other clinical outcomes. RESULTS: During the follow-up, LVMi in PPM patients decreased significantly from 139.6 ± 20.8 to 119.6 ± 26.5 g/m (P < 0.001). These patients were divided into two groups according to the median value of the reduction rate of LVMi at final follow-up, and preoperative GLS markedly decreased in PPM patients with insignificant reduction in LVMi. Multivariate analysis identified preoperative GLS (odds ratio 3.45, 95% confidence interval 1.27-11.05, P = 0.002) and preoperative LVMi (odds ratio 2.87, 95% confidence interval 1.21-8.13, P = 0.012) as independently associated with an insignificant LVMR. Moreover, PPM patients with limited reduction in LVMi were at an increased risk of cardiac death and major adverse valve-related events. CONCLUSION: In patients with aortic PPM early after surgery, reduced preoperative GLS could be a novel sensitive risk factor for a limited regression of LV hypertrophy, and this is associated with an increased risk of adverse events in PPM patients.
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Zhang et al. (2019) conducted a cohort in Aortic stenosis with prosthesis-patient mismatch (n=256). Preoperative global longitudinal strain (GLS) was evaluated on Insignificant left ventricular mass regression (LVMR) (OR 3.45, 95% CI 1.27-11.05, p=0.002). Reduced preoperative global longitudinal strain was independently associated with insignificant left ventricular mass regression (OR 3.45; 95% CI 1.27-11.05; P=0.002) in patients with aortic PPM.
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