Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement

Delgado, Victoria; Tops, Laurens F.; Bommel, Rutger J. van; Kley, Frank van der; Marsan, Nina Ajmone; Klautz, Robert J.M.; Versteegh, Michel I.M.; Holman, Eduard R.; Schalij, Martin J.; Bax, Jeroen J.

doi:10.1093/eurheartj/ehp351

Cited by 239 publications

(207 citation statements)

References 32 publications

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“…These observations are not confirmed by Donal et al [4]. In the study by Delgado et al [6], patients with severe AS had significantly lower GLS compared to patients with hypertension with a similar degree of LV hypertrophy. The authors hypothesised that in patients with severe AS the deterioration of the function of ventricular longitudinal fibres is more affected by the degree of aortic valve stenosis and associated impairment of coronary blood flow.…”

Section: Discussionmentioning

confidence: 78%

“…Changes in LV global longitudinal strain (GLS) assessed using speckle tracking echocardiography may be used as such an indicator. The usefulness of this parameter in detecting subtle changes in LV function secondary to various pathologies and their prognostic significance was shown also in AS [6][7][8]. Still little is known about the importance of exercise-induced changes in GLS in patients with high-gradient asymptomatic severe AS [4,5,9,10].…”

Section: Introductionmentioning

confidence: 98%

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Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe aortic stenosis

et al. 2017

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A b s t r a c t Background:The management of patients with asymptomatic severe aortic stenosis (ASAS) is still under discussion. Therefore, it is advisable to search for the parameters of early damage to left ventricular (LV) function. Aim:The aim of the study was to assess exercise-induced changes in LV global longitudinal strain (GLS) in ASAS. Methods:The ASAS group consisted of 50 patients (26 women and 24 men, aged 38.4 ± 18.1 years) meeting the echocardiographic criteria of severe aortic stenosis (AVA < 1 cm 2 , AVAI < 0.6 cm 2 /m 2 , Vmax > 4 m/s, mean aortic gradient > 40 mm Hg), with normal LV ejection fraction (LVEF ≥ 55%) and sinus rhythm on electrocardiogram, and without significant concomitant valvular heart diseases. The control group consisted of 21 people matched for age and sex. Echocardiographic examinations and echocardiographic stress tests with the assessment of GLS using the speckle tracking imaging were performed. Results:The ASAS group was characterised by statistically significantly higher LV mass index (LVMI) and higher LVEF. GLS values at rest in both groups were within normal limits but were significantly higher in the control group (-18.9 ± 2.4% vs. -20.7 ± 1.7%, p = 0.006). An increase in GLS at peak exercise in both groups was observed, lower in the ASAS group (the difference was not statistically significant: -0.8 ± 3.0% vs. -2.2 ± 3.1%, p = 0.086). Changes in GLS during exercise (∆GLS) did not correlate with the parameters of the severity of aortic stenosis. In the multivariate model, LVMI proved to be a factor associated with GLS at rest and during exercise. Conclusions:In patients with ASAS, GLS is a non-invasive marker of an early stage of LV myocardial damage associated with myocardial hypertrophy. An increase in GLS during exercise in the ASAS group, smaller than in the control group, indicates a preserved functional reserve of the LV myocardium but smaller than in healthy individuals. The assessment of the clinical usefulness of exercise-induced changes in GLS requires further research.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 98%

Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe aortic stenosis

et al. 2017

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“…More sensitive parameters useful to assess contractile status are: +dP/dt max [38] normalized by LVEDP, and SGLS, which allows to assess contractile properties of the myocardium [39] in various scenarios including AS [13], confirmed the impairment of systolic function, especially in decompensated groups, and could thus be useful tools to characterize subtle changes in ventricular function. Interestingly, a significant positive correlation was observed between both parameters assessing LV contractile status.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging with two-dimensional (2D) strain has been shown to be an appropriate method to assess myocardial contractility, as well as structure, and could be used to detect changes in LV performance [13,14].…”

Section: Introductionmentioning

confidence: 99%

Severe aortic stenosis with preserved ejection fraction and evidence of impairment in structure, myocardial strain and ventricular function: A new contribution to clinical decision making

et al. 2015

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Background: Left ventricular ejection fraction (LVEF) is among the parameters that are usually employed to define surgical timing of severe aortic stenosis (AS G1: 328 ± 66, G2a: 376 ± 22, G2b: 385 ± 13, p < 0.01; collagen volume [%]: G1: 4.77 ± 1.27, G2a: 8.40 ± 1.27, G2b: 11.05 ± 3.08, p < 0.01; LVEDP normalized by diastolic diameter [mm Hg/mm]: G1: 0.27 ± 0.01, G2a: 0.39 ± 0.06, G2b: 0.44 ± 0.11, p < 0.02; +dP/dt max /LVEDP [mm Hg/s/mm Hg]: G1: 176 ± 45, G2a: 89.6 ± 20, G2b: 113.1 ± 41, p < 0.01; p < 0.05 (Cardiol J 2015; 22, 6: 613-621)

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“…Therefore, objective and reproducible parameters that identify early LV dysfunction, before a drop in LVEF could potentially allow more appropriate timing of surgery and in turn, allow improved survival. Over the past decade, the relationship between global LV load and abnormal LV systolic performance in AS patients, even in those with preserved LVEF has become more apparent, and the use of novel echocardiographic measures of LV load (Zva)19, 20, 45 and LV systolic performance (LV‐GLS)18, 30, 46 have been proposed as potential markers of early dysfunction, providing incremental prognostic utility.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction Undergoing Rest and Treadmill Stress Echocardiography

Huded

Masri

Kusunose

et al. 2018

JAHA

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BackgroundIn asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction, we sought to assess the incremental prognostic value of resting valvuloarterial impedence (Zva) and left ventricular global longitudinal strain (LV‐GLS) to treadmill stress echocardiography.Methods and ResultsWe studied 504 such patients (66±12 years, 78% men, 32% with coronary artery disease who underwent treadmill stress echocardiography between 2001 and 2012. Clinical and exercise variables (% of age‐sex predicted metabolic equivalents [%AGP‐METs]) were recorded. Resting Zva ([systolic arterial pressure+mean aortic valve gradient]/[LV‐stroke volume index]) and LV‐GLS (measured offline using Velocity Vector Imaging, Siemens) were obtained from the baseline resting echocardiogram. Death was the primary outcome. There were no major adverse cardiac events during treadmill stress echocardiography. Indexed aortic valve area, Zva, and LV‐GLS were 0.46±0.1 cm2/m2, 4.5±0.9 mm Hg/mL per m2 and −16±4%, respectively; only 50% achieved >100% AGP‐METs. Sixty‐four percent underwent aortic valve replacement. Death occurred in 164 (33%) patients over 8.9±3.6 years (2 within 30 days of aortic valve replacement). On multivariable Cox survival analysis, higher Society of Thoracic Surgeons score (hazard ratio or HR 1.06), lower % AGP‐METS (HR 1.16), higher Zva (HR 1.25) and lower LV‐GLS (HR 1.12) were associated with higher longer‐term mortality, while aortic valve replacement (HR 0.45) was associated with improved survival (all P<0.01). Sequential addition of ZVa and LV‐GLS to clinical model (Society of Thoracic Surgeons score and %AGP‐METs) increased the c‐statistic from 0.65 to 0.69 and 0.75, respectively, both P<0.001); findings were similar in the subgroup of patients who underwent aortic valve replacement.ConclusionsIn asymptomatic patients with severe aortic stenosis undergoing treadmill stress echocardiography, LV‐GLS and ZVa offer incremental prognostic value.

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Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement

Abstract: In severe AS patients, impaired LV S-and-SR existed although LVEF was preserved. After AVR, a significant S-and-SR improvement in all the three directions was observed. These subtle changes in LV contractility can be detected by 2D-STI.

Cited by 239 publications

References 32 publications

Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe aortic stenosis

Exercise-induced changes in left ventricular global longitudinal strain in asymptomatic severe aortic stenosis

Severe aortic stenosis with preserved ejection fraction and evidence of impairment in structure, myocardial strain and ventricular function: A new contribution to clinical decision making

Outcomes in Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction Undergoing Rest and Treadmill Stress Echocardiography

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