Key result
Decreased left ventricular global longitudinal strain (≥-9.92%) on preoperative computed tomography was an independent predictor of major adverse cardiovascular events after transcatheter aortic valve replacement (HR 4.45).
Why the study?
The study evaluated the utility of myocardial strain analysis on CT using state-of-the-art image analysis software to predict prognosis after TAVR.
Does preoperative left ventricular global longitudinal strain measured on computed tomography predict major adverse cardiovascular events in patients undergoing TAVR for severe aortic stenosis?
Cohort (n=126)
No
Does preoperative left ventricular global longitudinal strain measured on computed tomography predict major adverse cardiovascular events in patients undergoing TAVR for severe aortic stenosis?
Preoperative CT-derived left ventricular global longitudinal strain is a sensitive and independent predictor of adverse cardiovascular outcomes in patients undergoing TAVR.
CT myocardial strain may refine post-TAVR risk stratification; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: This study evaluated the utility of myocardial strain analysis on computed tomography (CT) using state-of-the-art image analysis software to predict the prognosis of patients who underwent transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: We included 126 patients with severe aortic valve stenosis (AS) who underwent preoperative CT. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death (including unknown death based on medical records), hospitalization due to heart failure, and fatal arrhythmia. Twenty-four (19%) patients experienced MACE. Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS) of the left ventricular (LV) myocardium (LVM), LV ejection fraction on CT, and the percentage of patients administered aspirin or statins was significantly lower among patients with than without MACE (all P<0.05). The percentage of patients with AF, a history of congestive heart failure, and tolvaptan or oral anticoagulants administration was significantly higher among patients with than without MACE (all P<0.05). In multivariate survival analysis using a Cox proportional hazard model, LV-GLS ≥-9.92% on CT (hazard ratio [HR] 4.45; 95% confidence interval [CI] 1.89-10.48; P=0.0007) and aspirin (HR 0.27; 95% CI 0.10-0.70; P=0.0074) or statin (HR 0.33; 95% CI 0.13-0.84; P=0.02) administration were significant predictors of prognosis after TAVR. CONCLUSIONS: Our findings indicate that LV-GLS on CT is a sensitive predictor of prognosis after TAVR.
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Matsumoto et al. (2025) conducted a cohort in Severe aortic valve stenosis (n=126). Decreased left ventricular global longitudinal strain (LV-GLS ≥-9.92%) on CT vs. Higher LV-GLS (<-9.92%) on CT was evaluated on Composite of cardiac death, hospitalization for heart failure, and fatal arrhythmia (MACE) (HR 4.45, 95% CI 1.89-10.48, p=0.0007). Decreased left ventricular global longitudinal strain (≥-9.92%) on preoperative computed tomography was an independent predictor of major adverse cardiovascular events after transcatheter aortic valve replacement (HR 4.45).
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