Key result
Lack of contractile reserve by GLS is linked to ~98% higher MACE in asymptomatic severe AS.
Why the study?
Contractile reserve during exercise stress echo estimated by GLS could better stratify asymptomatic patients with severe aortic stenosis who might benefit from early intervention.
Does the presence of contractile reserve assessed by global longitudinal strain improve event-free survival in patients with asymptomatic severe aortic stenosis?
Observational (n=101)
Single-blind
No
Does the presence of contractile reserve assessed by global longitudinal strain improve event-free survival in patients with asymptomatic severe aortic stenosis?
In patients with asymptomatic severe aortic stenosis, the absence of contractile reserve assessed by global longitudinal strain during exercise stress echocardiography is an independent predictor of major cardiovascular events.
Should not yet change practice in asymptomatic severe aortic stenosis; hypothesis-generating for GLS contractile reserve in risk stratification.
Background. Left ventricle (LV) global longitudinal strain (GLS) at rest has shown prognostic value in patients (pts) with severe aortic stenosis (SAS). Contractile reserve (CR) during exercise stress echo (ESE) estimated via GLS (CR-GLS) could better stratify the asymptomatic patients who could benefit from early intervention. Aims. To determine the long-term prognostic value of CR-GLS in patients with asymptomatic SAS with an ESE without inducible ischemia. Additionally, to compare the prognostic value of CR assessed via ejection fraction (CR-EF) and CR-GLS. Methods. In a prospective, single-center, observational study between 2013 and 2019, 101 pts with asymptomatic SAS and preserved left ventricular ejection fraction (LVEF) > 55% were enrolled. CR was considered present with an exercise-rest increase in LVEF (Simpson’s rule) ≥ 5 points and > 2 absolute points in GLS. Patients were assigned to 2 groups (G): G1: 56 patients with CR-GLS present; and G2: 45 patients CR-GLS absent. All patients were followed up. Results. G2 Patients were older, with lower exercise capability, less aortic valve area (AVA), a higher peak aortic gradient, and less LVEF (71.5% ± 5.9 vs. 66.8% ± 7.9; p = 0.002) and GLS (%) at exercise (G1: −22.2 ± 2.8 vs. G2: −18.45 ± 2.4; p = 0.001). During mean follow-up of 46.6 ± 3.4 months, events occurred in 45 pts., with higher incidence in G2 (G2 = 57.8% vs. G1 = 42.2%, p < 0.01). At Cox regression analysis, CR-GLS was an independent predictor of major cardiovascular events (HR: 1.98, 95% CI 1.09–3.58, p = 0.025). Event-free survival was lower for patients with CR-GLS absent (log rank test p = 0.022). CR-EF was not outcome predictive (log rank test p 0.095). Conclusions: In patients with asymptomatic SAS, the absence of CR-GLS during ESE is associated with worse prognosis. Additionally, CR-GLS was a better predictor of events than CR-EF.
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Arbucci et al. (2022) conducted an observational in Asymptomatic Severe Aortic Stenosis (SAS) (n=101). Absence of contractile reserve assessed by global longitudinal strain (CR-GLS) vs. Presence of CR-GLS was evaluated on Major cardiovascular events (acute myocardial infarction, stroke, or death/valve replacement) (HR 1.98, 95% CI 1.09-3.58, p=0.025). In patients with asymptomatic severe aortic stenosis, the absence of contractile reserve assessed by global longitudinal strain independently predicted major cardiovascular events (HR 1.98).
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