Incremental Predictive Value of Longitudinal Axis Strain and Late Gadolinium Enhancement Using Standard CMR Imaging in Patients with Aortic Stenosis

Agoşton-Coldea, Lucia; Bheecarry, Kunal; Cionca, Carmen; Petra, Cristian; Strimbu, Lelia; Ober, Camelia; Lupu, Silvia; Fodor, Daniela; Mocan, Teodora

doi:10.3390/jcm8020165

Cited by 8 publications

(4 citation statements)

References 33 publications

(40 reference statements)

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“…Importantly, only one study found that BNP was not significantly associated with all-cause mortality [26]. Similarly, 23 of the NT-proBNP studies reported all-cause mortality [6,17,22,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and the other 10 studies reported composite mortality outcomes such as MACE [59][60][61][62][63][64][65][66][67][68]. Again, only one study found that NT-proBNP was not significantly associated with all-cause mortality [52].…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis

et al. 2021

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The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis (AS) and may be of use as mortality predictors. The aim of this systematic review and meta-analysis is to evaluate the blood biomarkers utilised in AS and assess whether they associate with mortality. PubMed and Embase were searched for studies reporting baseline biomarker level and mortality outcomes in patients with AS. A total of 83 studies met the inclusion criteria and were systematically reviewed. Of these, 21 reporting brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were meta-analysed. Pooled analysis demonstrated that all-cause mortality was significantly associated with elevated baseline levels of BNP (HR 2.59; 95% CI 1.95–3.44; p < 0.00001), NT-proBNP (HR 1.73; 95% CI 1.45–2.06; p = 0.00001), Troponin (HR 1.65; 95% CI 1.31–2.07; p < 0.0001) and Galectin-3 (HR 1.82; 95% CI 1.27–2.61; p < 0.001) compared to lower baseline biomarker levels. Elevated levels of baseline BNP, NT-proBNP, Troponin and Galectin-3 were associated with increased all-cause mortality in a population of patients with AS. Therefore, a change in biomarker level could be considered to refine optimal timing of intervention. The results of this meta-analysis highlight the importance of biomarkers in risk stratification of AS, regardless of symptom status.

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Section: Natriuretic Peptidesmentioning

confidence: 99%

Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis

et al. 2021

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“…In a multi-ethnic study, LAS was also associated with LVEF and MACEs [34]. In a study conducted on patients with aortic stenosis, our research team identified that LAS was an independent predictor of outcome and provided incremental value beyond LVEF and LGE [35]. Lastly, in patients with NIDCM, a single study identified that LAS was an independent predictor for SCD, aborted SCD, heart transplantation and HF hospitalization [36].…”

Section: Discussionmentioning

confidence: 96%

Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

Cojan-Minzat

Zlibut

Mureşan

et al. 2020

JCM

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To investigate the relationship between left ventricular (LV) long-axis strain (LAS) and LV sphericity index (LVSI) and outcomes in patients with nonischemic dilated cardiomyopathy (NIDCM) and myocardial replacement fibrosis confirmed by late gadolinium enhancement (LGE) using cardiac magnetic resonance imaging (cMRI), we conducted a prospective study on 178 patients (48 ± 14.4 years; 25.2% women) with first NIDCM diagnosis. The evaluation protocol included ECG monitoring, echocardiography and cMRI. LAS and LVSI were cMRI-determined. Major adverse cardiovascular events (MACEs) were defined as a composite outcome including heart failure (HF), ventricular arrhythmias (VAs) and sudden cardiac death (SCD). After a median follow-up of 17 months, patients with LGE+ had increased risk of MACEs. Kaplan-Meier curves showed significantly higher rate of MACEs in patients with LGE+ (p < 0.001), increased LVSI (p < 0.01) and decreased LAS (p < 0.001). In Cox analysis, LAS (HR = 1.32, 95%CI (1.54–9.14), p = 0.001), LVSI [HR = 1.17, 95%CI (1.45–7.19), p < 0.01] and LGE+ (HR = 1.77, 95%CI (2.79–12.51), p < 0.0001) were independent predictors for MACEs. In a 4-point risk scoring system based on LV ejection fraction (LVEF) < 30%, LGE+, LAS > −7.8% and LVSI > 0.48%, patients with 3 and 4 points had a significantly higher risk for MACEs. LAS and LVSI are independent predictors of MACEs and provide incremental value beyond LVEF and LGE+ in patients with NIDCM and myocardial fibrosis.

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“…Furthermore, patients with moderate AS and i-lowLVM might progress into severe AS with a/e-LVM, which also limits the interpretation of our cross-sectional analysis due to the missing information on time-dependent changes of LVM and LV mechanics. Second, from available medical records, we were able to derive only mwFS as a better estimate of LV function than EF, while novel echocardiographic techniques, i.e., strain analysis [31], might provide a better insight into LV contractility. Third, we analyzed a heterogeneous group of consecutive AS subjects.…”

Section: Discussionmentioning

confidence: 99%

Better Myocardial Function in Aortic Stenosis with Low Left Ventricular Mass: A Mechanism of Protection against Heart Failure Regardless of Stenosis Severity?

Chyrchel

Bolt

Długosz

et al. 2019

JCM

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About one-tenth to one-third of patients with severe aortic stenosis (AS) do not develop left ventricular hypertrophy (LVH). Intriguingly, the absence of LVH despite severe AS is associated with lower prevalence of heart failure (HF), which challenges the classical notion of LVH as a beneficial compensatory response. Notably, the few studies that have attempted to characterize AS subjects with inadequately low left ventricular (LV) mass relative to LV afterload (i-lowLVM) described better prognosis and enhanced LV performance in AS associated with i-lowLVM, but those reports were limited to severe AS. Our aim was to compare myocardial function between moderate and severe AS with i-lowLVM. We retrospectively analyzed in-hospital records of 225 clinically stable nondiabetic patients with isolated moderate or severe degenerative AS in sinus rhythm, free of coexistent diseases. Subjects with i-lowLVM were compared to those with appropriate or excessive LVM (a/e-LVM), defined on the basis of the ratio of a measured LVM to the LVM predicted from an individual hemodynamic load. Patients with i-lowLVM and a/e-LVM did not differ in aortic valve area, LV end-diastolic diameter (LVd, a measure of LV preload), and circumferential end-systolic LV wall stress (cESS), an estimate of LV afterload. Compared to a/e-LVM, patients with i-lowLVM had increased LV ejection fraction (EF) and especially higher LV midwall fractional shortening (a better index of LV myocardial function than EF in concentric LV geometry) (p < 0.001–0.01), in both moderate and severe AS. LVd and cESS were similar in the four subgroups of the study subjects, i.e., moderate AS with i-lowLVM, moderate AS with a/e-LVM, severe AS with i-lowLVM, and severe AS with a/e-LVM (p > 0.6). Among patients with i-lowLVM, LVM did not differ significantly between moderate and severe AS (p > 0.4), while in those with a/e-LVM, LVM was increased in severe versus moderate AS (p < 0.001). In conclusion, the association of the low-LVM phenotype with better myocardial contractility may already develop in moderate AS. Additionally, cESS appears to be a controlled variable, which is kept constant over AS progression irrespective of LVM category, but even when controlled (by increasing LVM), is not able to prevent deterioration of LV function. Whether improved myocardial performance contributes to favorable prognosis and the preventive effect against HF in AS without LVH, remains to be studied.

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Incremental Predictive Value of Longitudinal Axis Strain and Late Gadolinium Enhancement Using Standard CMR Imaging in Patients with Aortic Stenosis

Cited by 8 publications

References 33 publications

Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis

Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis

Left Ventricular Geometry and Replacement Fibrosis Detected by cMRI Are Associated with Major Adverse Cardiovascular Events in Nonischemic Dilated Cardiomyopathy

Better Myocardial Function in Aortic Stenosis with Low Left Ventricular Mass: A Mechanism of Protection against Heart Failure Regardless of Stenosis Severity?

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