Key result
Patients with severe aortic stenosis and significant symptoms had worse peak longitudinal systolic strain rates than those with no or mild symptoms (-83.352 vs -106.301 %/s; P=0.048).
Why the study?
Does myocardial strain measured by CMR differ between severe aortic stenosis patients with none/mild symptoms versus significant symptoms?
Cross-Sectional (n=55)
Does myocardial strain measured by CMR differ between severe aortic stenosis patients with none/mild symptoms versus significant symptoms?
Absolute Event Rate: -83.352% vs -106.301%
p-value: p=0.048
Patients with severe aortic stenosis and preserved LVEF exhibit significant subclinical myocardial dysfunction on CMR regardless of symptom severity, suggesting borderline symptoms should not delay intervention.
Borderline symptoms in severe AS warrant caution given equivalent strain impairment; leaves open strain-guided AVR timing in equivocal cases.
Background: Symptomatic severe aortic stenosis (AS) is a class I indication for replacement in patients when left ventricular ejection fraction (LVEF) is preserved. However, symptom reporting is often equivocal and decision making can be challenging. We aimed to quantify myocardial deformation using cardiovascular magnetic resonance (CMR) in patients classified by symptom severity. Methods: Forty-two patients with severe AS referred to heart valve clinic were studied using tagged CMR imaging. All had preserved LVEF. Patients were grouped by symptoms as either “none/mild” (n=21, NYHA class I, II) or “significant” (n=21, NYHA class III, IV, angina, syncope) but were comparable for age (72.8±5.4 vs. 71.0±6.8 years old, P=0.345), surgical risk (EuroSCORE II: 1.90±1.7 vs. 1.31±0.4, P=0.302) and haemodynamics (peak aortic gradient: 55.1±20.8 vs. 50.4±15.6, P=0.450). Thirteen controls matched in age and LVEF were also studied. LV circumferential strain was calculated using inTag© software and longitudinal strain using feature tracking analysis. Results: Compared to healthy controls, patients with severe AS had significantly worse longitudinal and circumferential strain, regardless of symptom status. Patients with “significant” symptoms had significantly worse peak longitudinal systolic strain rates (−83.352±24.802%/s vs. −106.301±43.276%/s, P=0.048) than those with “no/mild” symptoms, with comparable peak longitudinal strain (PLS), peak circumferential strain and systolic and diastolic strain rates. Conclusions: Patients with severe AS who have no or only mild symptoms exhibit comparable reduction in circumferential and longitudinal fibre function to those with significant symptoms, in whom AVR is clearly indicated. Given these findings of equivalent subclinical dysfunction, reportedly borderline symptoms should be handled cautiously to avoid potentially adverse delays in intervention.
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Musa et al. (2017) conducted a cross-sectional in Severe aortic stenosis (n=55). Significant symptoms vs. No or mild symptoms was evaluated on Peak longitudinal systolic strain rate (p=0.048). Patients with severe aortic stenosis and significant symptoms had worse peak longitudinal systolic strain rates than those with no or mild symptoms (-83.352 vs -106.301 %/s; P=0.048).
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