The Prognostic Role of Late Gadolinium Enhancement in Aortic Stenosis

Papanastasiou, Christos A.; Kokkinidis, Damianos G.; Kampaktsis, Polydoros; Bikakis, Iosif; Cunha, Daniela K.; Oikonomou, Evangelos; Greenwood, John P.; García, Mario J.; Karamitsos, Theodoros D.

doi:10.1016/j.jcmg.2019.03.029

Cited by 33 publications

(15 citation statements)

References 35 publications

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“…Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging detects myocardial fibrosis and a positive LGE-CMR has been shown to be present in 49% of patients with AS. Myocardial fibrosis identified by LV biopsy staining or LGE-CMR independently predicts mortality [20][21][22]. Recently, co-existing transthyretin wild type cardiac amyloidosis (ATTRwt) has been demonstrated in AS patients undergoing TAVR with a prevalence of 16% [23].…”

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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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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show abstract

“…Late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging detects myocardial brosis and a positive LGE-CMR has been shown to be present in 49% of patients with AS. Myocardial brosis identi ed by LV biopsy staining or LGE-CMR independently predicts mortality [20][21][22]. Recently, co-existing transthyretin wild type cardiac amyloidosis (ATTRwt) has been demonstrated in AS patients undergoing TAVR with a prevalence of 16% [23].…”

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

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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“…6,7,20,21 Recently, several studies have proposed different imaging parameters to assess LV function and identify LV decompensation. [22][23][24] LV GLS was associated with long-term outcomes independently of AS severity and LVEF. 22 Localized and diffuse LV fibrosis assessed using cardiac magnetic resonance late-gadolinium enhancement, T1 mapping, and extracellular volume assessment has shown a strong relation with prognosis in patients with severe AS.…”

Section: Evaluation Of LV Myocardial Function and Remodeling In Patients With Severe Asmentioning

confidence: 92%

“…22 Localized and diffuse LV fibrosis assessed using cardiac magnetic resonance late-gadolinium enhancement, T1 mapping, and extracellular volume assessment has shown a strong relation with prognosis in patients with severe AS. [23][24][25] Nevertheless, echocardiography remains the main imaging modality to diagnose and grade AS and also to assess LV adaptation to increased afterload. 26 Recently, Russell et al 8,9 developed a method to noninvasively calculate LV myocardial work indices, demonstrating that these parameters correlated well with invasive measures of myocardial work and metabolism evaluated using positron emission tomography.…”

Section: Evaluation Of LV Myocardial Function and Remodeling In Patients With Severe Asmentioning

confidence: 99%

Left Ventricular Myocardial Work in Patients with Severe Aortic Stenosis

Fortuni

Butcher

Kley

et al. 2021

Journal of the American Society of Echocardiography

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Background: Left ventricular myocardial work (LVMW) is a novel method to assess left ventricular (LV) function using pressure-strain loops that takes into consideration LV afterload. The estimation of LV afterload in patients with severe aortic stenosis (AS) may be challenging, and no study so far has investigated LVMW in this setting. The aim of this study was to develop a method to calculate LVMW in patients with severe AS and to analyze its relationship with heart failure symptoms.Methods: Indices of LVMW were calculated in 120 patients with severe AS who underwent transcatheter aortic valve replacement and invasive LV and aortic pressure measurements. LV systolic pressure was also derived by adding the mean aortic valve gradient to the aortic systolic pressure. LV global longitudinal strain and echocardiography-derived LV systolic pressure were then incorporated to construct pressure-strain loops of the left ventricle.Results: An excellent correlation was observed between LVMW indices calculated using the invasive and echocardiography-derived LV systolic pressure. Patients in New York Heart Association functional class III or IV (n = 97 [73%]) had lower LV global longitudinal strain, LV global work index, LV global constructive work, and right ventricular free wall strain compared with those in New York Heart Association functional class I or II. In contrast to LV global longitudinal strain, LV global work index (odds ratio per 100 mm Hg% increase, 0.91; 95% CI, 0.85-0.98; P = .012) and LV global constructive work showed independent associations with New York Heart Association functional class III or IV heart failure symptoms. Conclusions:The calculation of echocardiography-based LVMW indices is feasible in patients with severe AS. In particular, LV global work index and global constructive work showed independent associations with heart failure symptoms and may provide additional information on myocardial remodeling and function in patients with severe AS.

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The Prognostic Role of Late Gadolinium Enhancement in Aortic Stenosis

Cited by 33 publications

References 35 publications

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

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

Left Ventricular Myocardial Work in Patients with Severe Aortic Stenosis

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