Characterization of myocardial mechanics and its prognostic significance in patients with severe aortic stenosis undergoing aortic valve replacement

Figure 1. Receiver operating characteristic (ROC) analysis comparing baseline global longitudinal strain (GLS), global longitudinal systolic strain rate (GLSRs), and valvulo-arterial impedance (Zva) to accurately identify patients who will experience a gain in GLS of ≥20% after aortic valve replacement (AVR). A baseline GLS more negative than −16.2% had a sensitivity of 90% and a specificity of 67% to predict short-term recovery of GLS of ≥20% post-AVR.

Figure 2. Survival analysis in patients with severe aortic stenosis post aortic valve replacement (AVR) according to: (A) global longitudinal strain (GLS) response to AVR; (B) baseline global circumferential strain (GCS); (C) baseline global circumferential systolic strain rate (GCSRs); and (D) baseline basal rotation. Cutoff values for GCS, GCSRs, and basal rotation were determined from receiver operating characteristic (ROC) analyses. There was a trend towards increased all-cause mortality when the baseline GCS was less negative than −26%. A GCSRs less negative than −1.9% and a basal rotation less negative than −5.4% predicted lower survival. *GCSRs and basal rotation remained statistically significant after adjusting for age and gender.

Figure 3. Combined model of aortic stenosis progression that incorporates the earlier subclinical changes in myocardial mechanics with the later stage changes proposed by Généreux et al.43 Decompensation appears to be heralded by a failure of compensatory mechanisms to preserve left ventricular ejection fraction, which occurs when there is an insufficient increase or decline in global circumferential strain, apical rotation, and peak systolic twist. Abbreviations: AS, aortic stenosis; GLS, global longitudinal strain; GCS, global circumferential strain; GCSRs, global circumferential systolic strain rate; LA, left atrial; LV, left ventricular; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; PH, pulmonary hypertension; RV, right ventricular; TR, tricuspid regurgitation.