Key result
Impaired 2D global longitudinal peak strain (cutoff of -17.9%) was associated with a 3.9-fold increased relative risk of clinical cardiac events in asymptomatic aortic stenosis patients with preserved ejection fraction.
Why the study?
To identify the most valuable CMR-FT parameters for evaluating AS and determine if they predict prognosis in asymptomatic patients with preserved EF.
Does 2D global longitudinal peak strain assessed by CMR feature tracking predict clinical cardiac events in asymptomatic aortic stenosis patients with preserved ejection fraction?
Cohort (n=155)
No
Does 2D global longitudinal peak strain assessed by CMR feature tracking predict clinical cardiac events in asymptomatic aortic stenosis patients with preserved ejection fraction?
Relative Risk: 3.9 (95% CI 1.2–11.9)
p-value: p=0.016
2D global longitudinal peak strain assessed by CMR feature tracking is an independent prognostic predictor of clinical cardiac events in asymptomatic patients with moderate to severe aortic stenosis and preserved ejection fraction.
May support risk stratification with CMR-FT GLS in asymptomatic AS with preserved EF; leaves open need for prospective validation before guiding intervention.
Objective: To determine the most valuable cardiac magnetic resonance feature tracking (CMR-FT) parameters for evaluating aortic stenosis (AS) and determine whether they can predict the prognosis in asymptomatic AS patients with preserved ejection fraction (pEF). Materials and Methods: A prospective cohort of 123 moderate to severe AS patients (60 males, 68.6 9.2 years) and 32 control subjects (14 males, 67.9 4.4 years) underwent echocardiography and 3T CMR imaging from 2011-2015. CMR cine images were analyzed using CMR-FT to assess the left ventricular radial, circumferential, and longitudinal peak strain (PS) in 2-and 3-dimensions. The primary endpoints were clinical cardiac events (CCEs), including cardiac death, heart failure, and AS-associated symptom development. For statistical analysis, logistic regression and log-rank tests were used. Results: Global PSs differed between AS patients and controls and between severe and moderate AS patients (p < 0.05). Twodimensional (2D) global radial and longitudinal PSs changed gradually with the severity of AS groups (p < 0.001). Twenty-two of 67 asymptomatic AS patients with pEF experienced CCEs during the follow-up (median: 31.1 months). 2D global longitudinal PS (GLPS) was the single risk factor for CCE (p = 0.017). The relative risk for CCE was 3.9 (p = 0.016, 95% confidence interval: 1.2-11.9) based on 2D GLPS with a cutoff of -17.9% according to receiver operating characteristic curve analysis. Survival analysis demonstrated that asymptomatic AS patients with pEF having impaired 2D GLPS experienced worse event-free survival than the others (p = 0.041). Conclusion: 2D global longitudinal and radial PSs may reflect cardiac dysfunction according to the degree of AS. 2D GLPS might be a prognostic predictor of CCEs in asymptomatic AS patients with pEF.
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Kim et al. (2020) conducted a cohort in Aortic Stenosis (n=155). Impaired 2D global longitudinal peak strain (GLPS ≤ -17.9%) vs. Preserved 2D GLPS (> -17.9%) was evaluated on Clinical cardiac events (CCEs), including cardiac death, heart failure, and AS-associated symptom development (RR 3.9, 95% CI 1.2-11.9, p=0.016). Impaired 2D global longitudinal peak strain (cutoff of -17.9%) was associated with a 3.9-fold increased relative risk of clinical cardiac events in asymptomatic aortic stenosis patients with preserved ejection fraction.
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