Global longitudinal strain is associated with better outcomes in transcatheter aortic valve replacement

Al–Rashid, Fadi; Totzeck, Matthias; Saur, Nadine; Jánosi, Rolf Alexander; Lind, Alexander; Mahabadi, Amir A.; Rassaf, Tienush; Mincu, Raluca-Ileana

doi:10.1186/s12872-020-01556-4

Cited by 24 publications

(18 citation statements)

References 44 publications

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“…Our study shows gives impetus to the thought of intervening early in aortic valve disease by incorporating strain analysis in evaluation of patients for aortic valve replacement. Similar results were observed in many other studies [ 5 , 23 – 26 ]. Al-Rashid et al found that the global longitudinal strain (GLS) 1 week following TAVR was comparable to that at baseline (−15,9 ± 4.3 vs −16.8 ± 4.1; p = NS) but significantly improved at 3 months following TAVR (−15.9 ± 4.3% vs. −19.5 ± 3.5%; p < 0.001).…”

Section: Discussionsupporting

confidence: 93%

“…Al-Rashid et al found that the global longitudinal strain (GLS) 1 week following TAVR was comparable to that at baseline (−15,9 ± 4.3 vs −16.8 ± 4.1; p = NS) but significantly improved at 3 months following TAVR (−15.9 ± 4.3% vs. −19.5 ± 3.5%; p < 0.001). GLS improves at 3 months after TAVR, while LV ejection fraction does not show a substantial change, signalling an early recovery of LV longitudinal function after the intervention [ 23 ]. Lozano Granero VC et al found that between baseline and discharge, only a modest but statistically significant improvement in GLS (global longitudinal strain) could be seen (GLS% −14.6 ± 5.0 at baseline; −15.7 ± 5.1 at discharge following AVR, p = 0.0116) [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Speckle tracking echocardiographic assessment of left ventricular function by myocardial strain before and after aortic valve replacement

Kaler¹,

Mahla²,

Mahla³

et al. 2022

Journal of the Saudi Heart Association

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Background & objectives In patients of aortic stenosis and regurgitation, pressure and volume effects on left ventricular function are occult and missed by routine echocardiography markers like ejection fraction (EF). Speckle tracking analysis by measuring global longitudinal strain and global circumferential strain seems to ascertain this occult LV function parameters at an early phase in a more comprehensive manner. Limited studies have examined these parameters pre/post aortic valve replacement (AVR). Methods 94 consecutive patients with symptomatic severe aortic stenosis (AS) or aortic regurgitation (AR), planned for AVR were included (as per set inclusion criteria) along with 15 normal controls-15 months prospective study. Routine echocardiography and speckle tracking imaging was done at baseline (pre AVR) and post AVR at 1st week, 1st month and 3rd month of follow up. Results 90 patients completed study (70 in AS and 20 in AR group). In AS group mean values (± 2 standard deviations) of global longitudinal strain (GLS) improved from a baseline −10.9% (± 3.9) to −19.4% (±3.8) at 3rd month (p value < 0.0001). Mean values of global circumferential strain (GCS) too improved from −17.3% (±4.5) to −21.4% (±3.6) respectively (p value < 0.0001). In AR group too mean values of global longitudinal strain progressed from a baseline −12.6% (±3.9) to −19.4% (±3.4) at three months of follow (p value < 0.0001) and mean values of global circumferential strain also progressed from −15.3% (±3.4) at baseline to −21.7% (±3.1) respectively (p value < 0.0001). Conclusion Magnitude of recovery of GLS and GCS after AVR was more as compared to recovery in EF. Poor GLS/GCS values at baseline were associated with lesser recovery pressing need for an earlier intervention.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Speckle tracking echocardiographic assessment of left ventricular function by myocardial strain before and after aortic valve replacement

Kaler¹,

Mahla²,

Mahla³

et al. 2022

Journal of the Saudi Heart Association

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“…Patients with LVGLS > − 14% had a reduced survival [ 8 , 25 ]. Furthermore, in a recent study Al-Rashid et al demonstrated that baseline LVGLS correlate significantly with postprocedural outcomes in 150 consecutive patients undergoing TAVR [ 26 ]. In addition, LVEF did not show any predictive value in terms of all-cause mortality, AV replacement or development of cardiac symptoms in the studies referred to above.…”

Section: Discussionmentioning

confidence: 99%

Distribution and prognostic value of left ventricular global longitudinal strain in elderly patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement

Povlsen

Rasmussen

Vase

et al. 2020

BMC Cardiovasc Disord

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Aims The aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival. Methods We included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available. Results Mean age was 80.1 ± 7.1 years and aortic valve area (AVA) index 0.4 ± 0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50 ± 13% and mean LVGLS was − 14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS > − 18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS > − 14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient > 30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS > − 14% (HR 1.79 [1.02–3.14], p = 0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS > − 14% in the total population (p < 0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p = 0.006). Conclusions In patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS > − 14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS > − 14%.

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“…Patients with LVGLS >-14% had a reduced survival [8,25]. Furthermore, in a recent study Al-Rashid et al demonstrated that baseline LVGLS correlate signi cantly with postprocedural outcomes in 150 consecutive patients undergoing TAVR [26]. In addition, LVEF did not show any predictive value in terms of all-cause mortality, AV replacement or development of cardiac symptoms in the studies referred to above.…”

Section: Marwick Et Al Have Previously Demonstrated That Lvgls Is Anmentioning

confidence: 93%

Distribution and Prognostic Value of Left Ventricular Global Longitudinal Strain in Elderly Patients with Symptomatic Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Povlsen

Rasmussen

Vase

et al. 2020

Preprint

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Aims The aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival.Methods We included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available. Results Mean age was 80.1±7.1 years and aortic valve area (AVA) index 0.4±0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50±13% and mean LVGLS was -14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS >-18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS >-14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient >30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS >-14% (HR 1.79 [1.02-3.14], p=0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS >-14% in the total population (p<0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p=0.006).Conclusions In patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS >-14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS >-14 %.

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Global longitudinal strain is associated with better outcomes in transcatheter aortic valve replacement

Cited by 24 publications

References 44 publications

Speckle tracking echocardiographic assessment of left ventricular function by myocardial strain before and after aortic valve replacement

Speckle tracking echocardiographic assessment of left ventricular function by myocardial strain before and after aortic valve replacement

Distribution and prognostic value of left ventricular global longitudinal strain in elderly patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement

Distribution and Prognostic Value of Left Ventricular Global Longitudinal Strain in Elderly Patients with Symptomatic Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

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