Key result
Strain imaging detects subclinical dysfunction and is advocated to replace LVEF in aortic stenosis.
Why the study?
Current aortic stenosis guidelines rely on LVEF to guide intervention thresholds, but LVEF fails to detect subtle myocardial damage, prompting evaluation of strain imaging to identify subclinical dysfunction.
Does strain imaging improve risk stratification and therapeutic decision-making compared to LVEF in patients with aortic stenosis?
Does strain imaging improve risk stratification and therapeutic decision-making compared to LVEF in patients with aortic stenosis?
Strain imaging may be superior to LVEF for detecting subclinical myocardial dysfunction and refining intervention thresholds in aortic stenosis.
May support strain for subclinical dysfunction in aortic stenosis; leaves open prospective validation before replacing LVEF.
Adverse ventricular remodeling is an inflexion point of disease progression in aortic stenosis (AS) and a major determinant of prognosis. Intervention before irreversible myocardial damage is of paramount importance to sustain favorable post-operative outcomes. Current guidelines recommend a left ventricular ejection fraction (LVEF)-based strategy to determine the threshold for intervention in AS. However, LVEF has several pitfalls: it denotes the left ventricular cavity volumetric changes and it is not suited to detecting subtle signs of myocardial damage. Strain has emerged as a contemporary imaging biomarker that describes intramyocardial contractile force, providing information on subclinical myocardial dysfunction due to fibrosis. A large body of evidence advocates its use to determine the switch from adaptive to maladaptive myocardial changes in AS, and to refine thresholds for intervention. Although mainly studied in echocardiography, studies exploring the role of strain in multi-detector row computed tomography and cardiac magnetic resonance are emerging. This review, therefore, summarizes contemporary evidence on the role of LVEF and strain imaging in AS prognosis, aiming to move from an LVEF-based to a strain-based approach for risk stratification and therapeutic decision-making in AS.
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Anastasiou et al. (2023) conducted a review in Aortic stenosis. Strain imaging vs. Left ventricular ejection fraction (LVEF) was evaluated. Strain imaging provides information on subclinical myocardial dysfunction and is advocated to replace LVEF for risk stratification and therapeutic decision-making in aortic stenosis.
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