Impact of Flow and Left Ventricular Strain on Outcome of Patients With Preserved Left Ventricular Ejection Fraction and Low Gradient Severe Aortic Stenosis Undergoing Aortic Valve Replacement

Kamperidis, Vasileios; Rosendael, Philippe J. van; Ng, Arnold C.T.; Katsanos, Spyridon; Kley, Frank van der; Debonnaire, Philippe; Joyce, Emer; Sianos, Georgios; Marsan, Nina Ajmone; Bax, Jeroen J.; Delgado, Victoria

doi:10.1016/j.amjcard.2014.09.030

Cited by 31 publications

(14 citation statements)

References 27 publications

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“…Nonetheless, there are studies that demonstrated the improvement of all three components of the strain in short-term follow-up on a small sample size or using intraprocedural transesophageal echocardiography, but only changes in GLS persisted during follow-up [42,43]. The analysis of our cohort data demonstrated that GLS correlates with the complication rate, concordant with other studies where GLS distinguished itself as a prognostic parameter for major adverse cardiac events and was superior to LVEF [18,22,44]. Mitral regurgitation, paravalvular leaks or permanent pacemaker implantation are also factors that influence on left ventricular recovery, but we could not observe any significant correlation in our cohort.…”

Section: Discussionsupporting

confidence: 90%

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

Al–Rashid

Totzeck

Saur

et al. 2020

BMC Cardiovasc Disord

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Background: Parameters that mark the timing of left ventricular (LV) reverse remodeling following transcatheter aortic valve replacement (TAVR) are incompletely defined. This study aims to identify the dynamics of LV strain derived from speckle tracking echocardiography in a cohort of patients with severe aortic stenosis (AS) who underwent TAVR and its correlation with postprocedural outcomes. Methods: We selected 150 consecutive patients (82 ± 4 years old, STS score 6.4 ± 6.2) who underwent transfemoral TAVR between 07/2016 and 12/2017 at our tertiary care center. All patients were evaluated at baseline, 1 week after TAVR, and 3 months following TAVR. Results: 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). No significant changes in global circumferential strain (GCS) and global radial strain (GRS) were detectable. The ejection fraction was significantly improved 1 week after the TAVR procedure. The baseline GLS correlated directly with the complication rate (R = 0.36, p = 0.005). The linear regression analysis showed that the main predictors of the improvement in the GLS at 3 months in our cohort were baseline GRS and GCS. Conclusion: GLS improves at 3 months after TAVR, while LV ejection fraction does not show a substantial change, signaling an early recovery of LV longitudinal function after the intervention. Additionally, GLS has a direct correlation with the postprocedural outcomes. GLS improvement might emerge as a valuable parameter for a tailored follow-up in TAVR patients.

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Section: Discussionsupporting

confidence: 90%

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

Al–Rashid

Totzeck

Saur

et al. 2020

BMC Cardiovasc Disord

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“…Even in the multivariate analysis, this difference in the GLSR was maintained. Recently, it has been reported that a deterioration of GLS in PLGAS would be a predictor of poor prognosis, suggesting a bene t in asymptomatic patients with early aortic valve replacement [23]. We have demonstrated this signi cant decrease in the longitudinal deformity despite the absence of difference in LVEF between the two groups.…”

Section: Discussionsupporting

confidence: 57%

Role of Exercise Testing and Speckle Tracking Echocardiography in Paradoxical Severe Aortic Stenosis

Marí‐López

Izquierdo‐Gómez

Laynez‐Cerdeña

et al. 2020

Preprint

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Background The clinical behavior and prognosis of patients with asymptomatic paradoxical low-gradient aortic stenosis (PLGAS) still remain controversial. Some authors consider PLGAS as an echocardiographically poorly quantified moderate AS (MAS). We aimed to investigate the clinical behavior of PLGAS by comparing it with that of asymptomatic high-gradient aortic stenosis (HG-AS) and MAS using transthoracic echocardiography (TTE) with speckle tracking imaging (STI) and cardiopulmonary exercise testing (CPET).Methods A cohort of 113 patients was included and categorized into three groups according to AS type: MAS (n=63), HG-AS (n=29), and PLGAS (n=21). Patients’ clinical data were obtained. Patients underwent 2D TTE with STI and CPET. Results There were no significant differences in the clinical variables between the three AS groups. In the multivariate multinomial logistic regression analysis, with PLGAS being the reference category, the most powerful variable for establishing a difference with HG-AS was the left ventricular mass (LVM) indexed by body-surface area (odds ratio [OR]=1.04, confidence interval [CI]=1.01-1.06, p<0.05). The MAS group showed a lower valvuloarterial impedance (OR=0.262, CI=0.12-0.59, p=0.001), fewer abnormal CPET (OR=0.198, CI=0.06-0.69, p<0.05), and higher left ventricle global longitudinal strain rate (GLSR) (OR=0.003, CI=0.00-0.35, p<0.05) than the PLGAS group.Conclusions TTE with STI and CPET established the clear differences between patients with asymptomatic PLGAS and those with asymptomatic MAS, as well as the similarities between patients with PLGAS and those with HG-AS. Our data identifies PLGAS as a completely different entity from MAS.

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“…Serial measurement of SVI and Z VA , as well as assessment of LV strain,14 35 36 may be helpful in guiding therapy. Several studies including relatively small numbers of patients with LF/LG AS and preserved EF have assessed the impact of surgical (AVR) and transcatheter AVR on survival (table 1)7 9 31 33–43; most demonstrated a benefit with AVR.…”

Section: Managementmentioning

confidence: 99%

The spectrum of low-output low-gradient aortic stenosis with normal ejection fraction

Pislaru

Pellikka

2016

Heart

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Low-flow, low-gradient (LF/LG) severe aortic stenosis (AS) with preserved ejection fraction refers to the condition of AS with aortic valve area ≤1 cm(2), stroke volume index <35 mL/m(2), mean aortic valve gradient <40 mm Hg and left ventricular ejection fraction ≥50%. This mismatch of aortic valve area suggesting severe stenosis and 'low' gradient in some patients has led to confusion as to the severity of stenosis. Conditions previously labelled as LF/LG severe AS include a spectrum, with measurement error probably being the most common cause of marked inconsistency between gradient, valve area and patient presentation. The presence of LG severe AS may be overestimated in petite patients, who may have aortic valve area slightly less than 1 cm(2)with only moderate AS. Concomitant cardiac conditions besides AS, including significant mitral and tricuspid regurgitation, intracardiac shunts and constrictive pericarditis, may contribute to reduced stroke volume, and evidence for these must be sought at the time of echocardiography. True LF/LG severe AS is associated with a unique and probably maladaptive remodelling pattern with smaller ventricles, increasing relative wall thickness, progressive worsening of diastolic function and higher afterload, as demonstrated by lower systemic arterial compliance, higher systemic vascular resistance and higher valvuloarterial impedance. Control of hypertension is essential to the appropriate management of patients with AS. Aortic valve replacement should be considered in patients with compelling evidence of severe AS who remain symptomatic despite optimal treatment of hypertension.

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Impact of Flow and Left Ventricular Strain on Outcome of Patients With Preserved Left Ventricular Ejection Fraction and Low Gradient Severe Aortic Stenosis Undergoing Aortic Valve Replacement

Cited by 31 publications

References 27 publications

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

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

Role of Exercise Testing and Speckle Tracking Echocardiography in Paradoxical Severe Aortic Stenosis

The spectrum of low-output low-gradient aortic stenosis with normal ejection fraction

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