Global Longitudinal Strain and Biomarkers of Cardiac Damage and Stress as Predictors of Outcomes After Transcatheter Aortic Valve Implantation

Abstract

Background Global longitudinal strain (GLS) is a sensitive measure of left ventricular function and a risk marker in severe aortic stenosis. We sought to determine whether biomarkers of cardiac damage (cardiac troponin) and stress (NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]) could complement GLS to identify patients with severe aortic stenosis at highest risk. Methods and Results From a multicenter prospective cohort of patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation, we measured absolute GLS (aGLS), cardiac troponin, and NT‐proBNP at baseline in 499 patients. Left ventricular ejection fraction <50% was observed in 19% and impaired GLS (aGLS <15%) in 38%. Elevations in cardiac troponin and NT‐proBNP were present in 79% and 89% of those with impaired GLS, respectively, as compared with 63% and 60% of those with normal GLS, respectively ( P <0.001 for each). aGLS <15% was associated with increased mortality in univariable analysis ( P =0.009), but, in a model with both biomarkers, aGLS, and clinical covariates included, aGLS was not associated with mortality; elevation in each biomarker was associated with an increased hazard of mortality (adjusted hazard ratio, >2; P ≤0.002 for each) when the other biomarker was elevated, but not when the other biomarker was normal (interaction P =0.015). Conclusions Among patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve implantation, elevations in circulating cardiac troponin and NT‐proBNP are more common as GLS worsens. Biomarkers of cardiac damage and stress are independently associated with mortality after transcatheter aortic valve implantation, whereas GLS is not. These findings may have implications for risk stratification of asymptomatic patients to determine optimal timing of valve replacement.

Proteomic architecture of frailty across the spectrum of cardiovascular disease

“…To derive proteomic correlates of frailty in advanced heart disease, we studied 809 individuals with severe AS from a multicenter prospective cohort study (Perry et al, 2022; Stein et al, 2022) where frailty measures were systematically collected, split into two samples: (1) a derivation sample ( N = 233) that had complete data on 12 measures of frailty and (2) a validation sample ( N = 576) comprised of the remainder of our multicenter AS cohort that did not have complete data on the 12 frailty measures (Table 1). Both samples had follow‐up for vital status.…”

“…The discovery cohort comes from a multicenter, prospective cohort study of participants with symptomatic, severe AS undergoing TAVI (Perry et al, 2022; Stein et al, 2022). A key strength of this cohort is the systematic, prospective assessment of frailty (defined below).…”

Metabolic Signatures of Cardiac Dysfunction, Multimorbidity, and Post–Transcatheter Aortic Valve Implantation Death

“…A complete assessment of vital status was performed between March and June 2020 for the multicenter cohort 16 (both derivation and validation) and between November and December 2016 for the single‐center cohort (validation).…”