Prognostic implications of impaired longitudinal left ventricular systolic function assessed by tissue Doppler imaging prior to transcatheter aortic valve implantation for severe aortic stenosis

Abstract

Change in longitudinal left ventricular (LV) systolic function serves as an early marker of the deleterious effect of aortic stenosis (AS) and other cardiac comorbidities on cardiac function. We explored the prognostic value of tissue Doppler imaging (TDI)-derived longitudinal LV systolic function, defined by the peak systolic average of lateral and septal mitral annular velocities (average S’) among symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). 297 consecutive patients with severe AS undergoing TAVI at three european centers with available average S’ at preprocedural echocardiography were retrospectively included. The primary endpoint was the Kaplan Meier estimate of all-cause mortality. After a median 18 months (IQR 12–18) follow-up, 36 (12.1%) patients had died. Average S’ was associated with all-cause mortality (per 1 cm/sec decrease: HR 1.29, 95%CI 1.03–1.60, p = 0.025), the cut-off of 6.5 cm/sec being the most accurate. Patients with average S’ < 6.5 cm/sec (55.2%) presented characteristics of more advanced LV remodeling and functional impairment along with higher burden of cardiac comorbidities, and experienced higher all-cause mortality (17.6% vs. 7.5%, p = 0.007), also when adjusted for in-study outcome predictors (adj-HR: 2.69, 95%CI 1.22–5.93, p = 0.014). Results were consistent among patients with preserved ejection fraction, normal-flow AS, high-gradient AS and in those without LV hypertrophy. Longitudinal LV systolic function assessed by average S’ is independently associated with long-term all-cause mortality among TAVI patients. An average S’ below 6.5 cm/sec best defines clinically meaningful reduced longitudinal systolic function and may aid clinical risk stratification in these patients.

Current and novel echocardiographic assessment of left ventricular systolic function in aortic stenosis—A comprehensive review

“…The benefit of adopting this parameter is the high temporal resolution, ease and reproducibility when evaluating myocardial motion throughout the cardiac cycle which can be broken down into systolic and diastolic components 42 . A recent study evaluating the assessment of mitral annular peak systolic (S’) velocities in severe AS patients identified that S’ is independently correlated with all‐cause mortality (per 1 cm/sec reduction: HR 1.29, 95% CI 1.03–1.60, p = .025), with an average S’ < 6.5 cm/sec illustrating progressive LV remodelling and higher mortality rates (17.6% vs. 7.5%, p = .007) when compared to those with averaged S' values above 6.5 cm/sec 41 . Another investigation evaluating the combined role of TDI and N‐terminal Pro‐Brain Natriuretic Peptide highlighted the increased incremental prognostic data in asymptomatic moderate to severe AS patients when compared to each parameter independently 43 .…”

“…Longitudinal function derived by amendments in filter settings used to visualize high‐intensity, low velocity signals allow the capability to interrogate myocardial motion over time at specific regions using pulse wave Doppler 37 . TDI is a well‐established, standardized approach to evaluate cardiac longitudinal function during TTE and validated in numerous cardiac comorbidities including diastolic dysfunction, 38 atrial fibrillation, 39 diabetes, 40 and AS 41 . The benefit of adopting this parameter is the high temporal resolution, ease and reproducibility when evaluating myocardial motion throughout the cardiac cycle which can be broken down into systolic and diastolic components 42 .…”

“… 37 TDI is a well‐established, standardized approach to evaluate cardiac longitudinal function during TTE and validated in numerous cardiac comorbidities including diastolic dysfunction, 38 atrial fibrillation, 39 diabetes, 40 and AS. 41 The benefit of adopting this parameter is the high temporal resolution, ease and reproducibility when evaluating myocardial motion throughout the cardiac cycle which can be broken down into systolic and diastolic components. 42 A recent study evaluating the assessment of mitral annular peak systolic (S’) velocities in severe AS patients identified that S’ is independently correlated with all‐cause mortality (per 1 cm/sec reduction: HR 1.29, 95% CI 1.03–1.60, p = .025), with an average S’ < 6.5 cm/sec illustrating progressive LV remodelling and higher mortality rates (17.6% vs. 7.5%, p = .007) when compared to those with averaged S' values above 6.5 cm/sec.…”

“… 42 A recent study evaluating the assessment of mitral annular peak systolic (S’) velocities in severe AS patients identified that S’ is independently correlated with all‐cause mortality (per 1 cm/sec reduction: HR 1.29, 95% CI 1.03–1.60, p = .025), with an average S’ < 6.5 cm/sec illustrating progressive LV remodelling and higher mortality rates (17.6% vs. 7.5%, p = .007) when compared to those with averaged S' values above 6.5 cm/sec. 41 Another investigation evaluating the combined role of TDI and N‐terminal Pro‐Brain Natriuretic Peptide highlighted the increased incremental prognostic data in asymptomatic moderate to severe AS patients when compared to each parameter independently. 43 While these results identify a use for TDI in AS patients, conflicting findings have also reported that S’ and diastolic (E’) TDI parameters offer minimal predictive information about symptomatic deterioration in the AS cohort.…”