Key result
GLS ≤ 15% linked to ~110% higher mortality in severe aortic stenosis with preserved LVEF.
Why the study?
To test whether GLS magnitude <= 15% using vendor-independent speckle-tracking software identifies severe AS patients at higher risk of death despite preserved LVEF and no or mild symptoms.
Does impaired global longitudinal strain (≤ 15%) predict all-cause mortality in patients with severe aortic stenosis, no or mild symptoms, and preserved LVEF?
Cohort (n=196)
Does impaired global longitudinal strain (≤ 15%) predict all-cause mortality in patients with severe aortic stenosis, no or mild symptoms, and preserved LVEF?
Hazard Ratio: 2.1 (95% CI 1.2–3.68)
p-value: p=0.009
Impaired global longitudinal strain (≤ 15%) identifies patients with severe aortic stenosis and preserved LVEF who are at higher risk of all-cause mortality, aiding in risk stratification.
GLS ≤15% may refine risk stratification in severe AS with preserved EF; extends prior observations but remains hypothesis-generating without prospective validation.
BACKGROUND: Impaired left ventricular (LV) speckle-tracking-derived global longitudinal strain (GLS) magnitude (GLS worse than 14.7%) has been associated with poor outcome in patients with severe aortic stenosis (AS) and preserved LV ejection fraction (EF). OBJECTIVES: To test the hypothesis that GLS magnitude ≤ 15% obtained with vendor-independent speckle-tracking strain software may be able to identify patients with severe AS who are at higher risk of death, despite preserved LVEF and no or mild symptoms. METHODS: ), no or mild symptoms, and LVEF ≥ 50%. Absolute values of GLS were collected. Survival analyses were carried out to study the impact of GLS magnitude on all-cause mortality. RESULTS: , and LVEF<60%) improved the predictive performance with improved global model fit, reclassification, and better discrimination. After propensity score matching (n = 196), increased risk of mortality persisted among patients with GLS magnitude ≤ 15% compared with those with GLS > 15% (hazard ratio = 2.10; 95% confidence interval, 1.20-3.68; P = .009). CONCLUSIONS: In this series of patients with severe AS, no or mild symptoms, and LVEF ≥ 50%, GLS obtained with vendor-independent speckle-tracking strain software was an effective tool to identify patients with a poor outcome. Detection of myocardial dysfunction by identifying GLS magnitude < 15% in patients with severe AS, no or mild symptoms, and LVEF ≥ 50%, can aid in risk assessment.
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Thellier et al. (2020) conducted a cohort in Severe aortic stenosis with preserved ejection fraction (n=196). Global longitudinal strain magnitude ≤ 15% vs. Global longitudinal strain magnitude > 15% was evaluated on All-cause mortality (HR 2.10, 95% CI 1.20-3.68, p=0.009). Global longitudinal strain ≤ 15% was associated with increased all-cause mortality in patients with severe aortic stenosis and preserved LVEF (HR 2.10; 95% CI 1.20-3.68; P=0.009).
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