Key result
Relative apical sparing pattern linked to ~3.7-fold higher risk of SCD or HF hospitalization.
Why the study?
To investigate the association between the relative apical sparing pattern of left ventricular longitudinal strain and outcomes in patients with severe aortic valve stenosis.
Does the presence of a relative apical sparing pattern (RASP) predict sudden cardiac death or heart failure admission in patients with severe aortic valve stenosis and preserved ejection fraction?
Cohort (n=156)
No
Does the presence of a relative apical sparing pattern (RASP) predict sudden cardiac death or heart failure admission in patients with severe aortic valve stenosis and preserved ejection fraction?
Hazard Ratio: 3.66 (95% CI 1.94–6.92)
Absolute Event Rate: 63% vs 22%
p-value: p=<0.01
The relative apical sparing pattern of longitudinal strain provides independent prognostic value for predicting sudden cardiac death and heart failure admissions in patients with severe aortic stenosis and preserved ejection fraction.
Should not yet change practice in severe AS with preserved EF; hypothesis-generating for strain-based prognostication.
BACKGROUNDS: The relative apical sparing pattern (RASP) of left ventricular (LV) longitudinal strain (LS) is frequently associated with cardiac amyloidosis. Elderly patients with aortic valve stenosis (AS) complicated by transthyretin amyloid cardiomyopathy have poor prognosis. Furthermore, deteriorated basal LS in AS patients has been reported to be associated with adverse outcome. We investigated the association between RASP and outcomes in patients with severe AS. METHODS: We retrospectively studied 156 consecutive patients with severe AS and preserved LV ejection fraction. RASP was assessed by both of semi-quantitative (sRASP) and quantitative (qRASP) methods. sRASP was defined as a deterioration of LS (≥-10%) in ≥ 5 (of 6) basal segments, relative to preserved LS (<-15%) in at least 1 apical segment. qRASP was calculated using the following formula: average apical LS/(average basal LS + average mid-ventricle LS); qRASP ≥ 1 was defined as positive. Patients were followed up to determine outcomes, which included sudden cardiac death or unexpected admission due to heart failure, over a median of 1.9 years. RESULTS: sRASP and qRASP were assessed in all patients, but 24 and 42 patients fulfilled the criteria for sRASP and qRASP, respectively. Both assessments were significantly associated with outcomes (n = 44; 28%). Furthermore, sRASP was significantly associated with outcome after adjusting for EuroSCORE, NYHA ≥ II, or global longitudinal strain. A model based on these covariates for predicting outcomes significantly improved by adding sRASP. CONCLUSION: RASP is observed in some patients with severe AS and provides additive prognostic information over conventional parameters.
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Saito et al. (2020) conducted a cohort in Severe aortic valve stenosis (n=156). Semi-quantitative relative apical sparing pattern (sRASP) vs. No sRASP was evaluated on Sudden cardiac death or unexpected admission due to heart failure (HR 3.66, 95% CI 1.94-6.92, p=<0.01). The presence of a semi-quantitative relative apical sparing pattern (sRASP) was significantly associated with an increased risk of sudden cardiac death or admission for heart failure (HR 3.66).
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