Key result
Basal longitudinal strain predicts events in severe asymptomatic AS but significant overlap limits isolated utility.
Why the study?
The prognostic value of longitudinal strain in patients with asymptomatic aortic stenosis and preserved LVEF remains debated.
Does basal longitudinal strain predict AS-related events in asymptomatic patients with aortic stenosis and preserved LVEF?
Cohort (n=140)
Does basal longitudinal strain predict AS-related events in asymptomatic patients with aortic stenosis and preserved LVEF?
p-value: p=0.03
While basal longitudinal strain predicts AS-related events in severe asymptomatic aortic stenosis at a population level, its significant overlap limits its utility as an isolated parameter for individual patient decision-making.
Basal longitudinal strain should not guide individual decisions in asymptomatic severe AS; leaves open its role in multivariable risk models.
Background Longitudinal strain has been proposed as a sensitive marker of left ventricular systolic dysfunction. However its prognostic value in patients with aortic stenosis (AS) remains debated. Methods In a prospective cohort of asymptomatic patients with at least mild, isolated AS and preserved left ventricular ejection fraction (LVEF), clinical, biological measurements, global longitudinal strain (GLS) and basal longitudinal strain (BLS) were performed at study entry. The occurrence of AS-related events (sudden death, congestive heart failure, new onset of symptoms) or aortic valve replacement within two years was recorded prospectively. Results A total of 140 patients were enrolled and 21 events occurred. In contrast to GLS, BLS was significantly correlated to AS severity ( p = 0.0006 with PV, p = 0.0002 with MPG, p = 0.01 with AVA, and p = 0.0009 with AVAi) and predicted the occurrence of AS-related events in the subset of severe AS in univariate analysis ( p = 0.03) and after adjustment for AVA ( p = 0.01), AVAi ( p = 0.01), PV ( p = 0.045), and MPG ( p = 0.05). However, there was an important overlap of baseline BLS values between patients who developed symptoms and those who did not and repeated BLS measurements showed no difference between baseline values and those obtained at the time of overt symptoms in nine patients ( p = 0.38). Conclusion BLS was statistically predictive of AS-related events in the subset of severe AS. However, overlap of BLS values between groups of symptomatic status and similar values at baseline and at the time of overt symptoms raise the question of its use at an individual level at least as a single isolated parameter.
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Melissopoulou et al. (2017) conducted a cohort in Asymptomatic aortic stenosis with preserved left ventricular ejection fraction (n=140). Basal longitudinal strain (BLS) was evaluated on Occurrence of AS-related events (sudden death, congestive heart failure, new onset of symptoms) or aortic valve replacement (p=0.03). Basal longitudinal strain predicted AS-related events in severe asymptomatic aortic stenosis (p=0.03), though significant overlap in values limits its utility as an isolated individual parameter.
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