Left ventricular longitudinal shortening in patients with aortic stenosis: relationship with symptomatic status

Tongue, Antonio; Dumesnil, Jean G.; Laforest, Isabelle; Theriault, C.; Durand, Louis-Gilles

doi:10.1016/s0735-1097(02)81885-x

Journal of the American College of Cardiology

2002

DOI: 10.1016/s0735-1097(02)81885-x

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Left ventricular longitudinal shortening in patients with aortic stenosis: relationship with symptomatic status

Antonio Tongue¹,

Jean G. Dumesnil²,

Isabelle Laforest³

et al.

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Cited by 23 publications

(36 citation statements)

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“…In patients with asymptomatic AS, impaired subendocardial function has been shown to be associated with impaired exercise tolerance and changes in symptomatic status during short-term follow-up. 6,22 Our results have extended these preliminary data by showing that the decrease in long-axis function can identify a subset of patients with moderate to severe asymptomatic AS at greater risk of developing cardiac events.…”

supporting

confidence: 70%

“…5 These structural and functional changes precede symptom development, predict changes in clinical status, and trigger B-type natriuretic peptide (BNP) release. 6,7 In AS, the BNP level correlates with the valve area, diastolic function, functional status, and symptomatic deterioration and might improve risk stratification. 8 -11 Tissue Doppler measurement of mitral annular velocities is a sensitive method for the detection of early abnormalities in LV longaxis function and improves the assessment of LV diastolic function.…”

mentioning

confidence: 99%

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Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

Lancellotti¹,

Moonen²,

Magné³

et al. 2010

The American Journal of Cardiology

130

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In aortic stenosis (AS), the increased afterload results in progressive structural and functional changes that precede the development of symptoms. We hypothesized that the detection of abnormalities in left ventricular long-axis function could identify patients with asymptomatic AS at increased risk of events. We prospectively examined the outcome of 126 patients with asymptomatic AS who underwent a comprehensive echocardiographic examination, including tissue Doppler imaging. B-type natriuretic peptide ( Aortic valve stenosis (AS) is the most common valvular disease and has become the most common cardiovascular disease, after coronary artery disease and hypertension, in developed countries. 1 AS is characterized by a long asymptomatic phase, lasting several decades, during which outflow obstruction progressively develops. 2 Aortic valve replacement is the sole effective therapy for symptomatic patients. In contrast, the management of asymptomatic AS remains controversial. 3,4 In these patients, the chronically increased afterload results in progressive left ventricular (LV) myocardial hypertrophy and interstitial fibrosis, diastolic dysfunction, elevated left atrial pressures, dilation of the left atrium, and, eventually, intrinsic myocardial dysfunction. 5 These structural and functional changes precede symptom development, predict changes in clinical status, and trigger B-type natriuretic peptide (BNP) release. 6,7 In AS, the BNP level correlates with the valve area, diastolic function, functional status, and symptomatic deterioration and might improve risk stratification. 8 -11 Tissue Doppler measurement of mitral annular velocities is a sensitive method for the detection of early abnormalities in LV longaxis function and improves the assessment of LV diastolic function. 12 In asymptomatic AS, the incremental prognostic value of tissue Doppler imaging and BNP measurement compared with validated parameters has never been investigated. The present study was undertaken to prospectively assess the comparative usefulness in predicting the clinical outcomes of long-axis function and BNP level in a series of patients with asymptomatic severe AS. MethodsAsymptomatic patients with severe AS were prospectively screened from our echocardiographic laboratory for inclusion in the present study. All the patients met the following criteria: (1) moderate to severe AS, as defined by an aortic valve area of Յ1.2 cm 2 ; (2) no symptoms according to a careful history taken by the referring physician; (3) normal LV ejection fraction (Ն55%), as calculated by 2-dimensional echocardiography; (4) no more than mild associated cardiac valve lesions; (5) sinus rhythm; and (6) serum creatinine Ͻ16 mg/L. A total of 126 patients met these criteria. The relevant institutional review boards approved the protocol, and all patients gave written informed consent.A comprehensive Doppler echocardiographic study, including M-mode, 2-dimensional echocardiography, color Doppler, and pulsed-wave and continuous-wave Doppler measurements was perform...

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supporting

confidence: 70%

mentioning

confidence: 99%

Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

Lancellotti¹,

Moonen²,

Magné³

et al. 2010

The American Journal of Cardiology

130

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“…31 Despite the absence of symptoms and a normal LVEF, patients with severe AS have an increased Zva. 33 In addition, this increased global afterload seems closely related to preclinical myocardial changes, identifiable by 2-dimensional strain, independent of the AS severity.…”

mentioning

confidence: 99%

“…29 Previous studies have shown longitudinal function to be an important marker of myocardial function in patients with severe AS and normal LVEF. [30][31][32] LV longitudinal shortening is more closely associated than ejection fraction with changes in symptom status, and may closely reflect alterations in subendocardial myocardial function. 31 Despite the absence of symptoms and a normal LVEF, patients with severe AS have an increased Zva.…”

mentioning

confidence: 99%

“…[30][31][32] LV longitudinal shortening is more closely associated than ejection fraction with changes in symptom status, and may closely reflect alterations in subendocardial myocardial function. 31 Despite the absence of symptoms and a normal LVEF, patients with severe AS have an increased Zva. 33 In addition, this increased global afterload seems closely related to preclinical myocardial changes, identifiable by 2-dimensional strain, independent of the AS severity.…”

mentioning

confidence: 99%

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Association of Myocardial Deformation With Outcome in Asymptomatic Aortic Stenosis With Normal Ejection Fraction

Yingchoncharoen

Gibby

Rodriguez

et al. 2012

Circ: Cardiovascular Imaging

161

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Background-Current guidelines recommend intervention for symptomatic aortic stenosis, but the management of asymptomatic aortic stenosis remains controversial. As left ventricular global longitudinal strain (GLS) has been shown to predict cardiovascular outcome, we sought to find whether its use could guide the assessment of risk in these patients. Methods and Results-We prospectively followed 79 patients with severe asymptomatic aortic stenosis (39 men; mean age, 77 ± 12 years; aortic valve [AV] area index, 0.36 cm 2 /m 2 ). In addition to standard echocardiography, speckle strain was measured to assess GLS. Patients were followed for cardiac death and AV replacement driven by symptom development. A multivariable Cox regression was performed to identify associations with events. During 23 ± 20 months, 3 patients had cardiac death and 49 underwent AV replacement. Event-free survival was 72 ± 5% at 1 year, 50 ± 5% at 2 years, and 24 ± 5% at 4 years. Death and AV replacement were predicted by GLS (hazard ratio [HR] Methods Patient SelectionThe study population included patients with severe AS who were studied in our echocardiography laboratory from March 2004 to August 2010. Severe AS was defined as AV area <1 cm 2 or transaortic jet velocity >4 m/s. Patients were excluded if they had any additional hemodynamically significant valvular lesions, presented with symptoms (angina, dyspnea, or syncope) or LV ejection fraction (LVEF)<50%. After these exclusions, we enrolled 79 patients (39 men; 77 ± 12 years; AV area index, 0.36 cm 2 ). The protocol was approved by the institutional review board of the Cleveland Clinic. Clinical CharacteristicsClinical data were entered prospectively into an electronic health record, including age, sex, height, weight, history of coronary artery disease (previous positive coronary angiogram or stress test), history of diabetes mellitus (fasting blood glucose >126 mg/dL on 2 occasions or patients currently receiving treatment for diabetes mellitus), history of hypercholesterolemia (total cholesterol >190 mg/dL or patients receiving lipid lowering agents), history of hypertension (blood pressure ≥140/90 mm Hg or patients receiving antihypertensive drugs) were collected at baseline. The Society of Thoracic Surgeons (STS) Predicted Risk of Morbidity or Mortality (STS-PRMM) for AV procedures was calculated by entering patient data into an online STS risk calculator (http://riskcalc.sts.org/ STSWebRiskCalc273/). The STS-PRMM uses 24 variables of >50 total risk factors collected by algorithm to predict mortality for valve procedures. 17 EchocardiographyPatients underwent a standard echocardiogram performed by experienced echocardiographers, using commercially available ultrasound systems. The LV dimensions, wall thickness, and outflow tract diameter were measured according to the recommendations of the American Society of Echocardiography. 18 The degree of calcification of the AV was scored as: (1) no calcification; (2) mildly calcified (small isolated foci); (3) moderately calcified (multipl...

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Prognostic Importance of Left Ventricular Global Longitudinal Strain in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction

Thellier

Altes

Appert

et al. 2020

Journal of the American Society of Echocardiography

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Left ventricular longitudinal shortening in patients with aortic stenosis: relationship with symptomatic status

Cited by 23 publications

References 0 publications

Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

Prognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis

Association of Myocardial Deformation With Outcome in Asymptomatic Aortic Stenosis With Normal Ejection Fraction

Prognostic Importance of Left Ventricular Global Longitudinal Strain in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction

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