Prognostic Importance of Left Ventricular Global Longitudinal Strain in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction

Thellier, Nicolas; Altes, Alexandre; Appert, Ludovic; Binda, Camille; Leman, Blandine; Marsou, Wassima; Debry, Nicolas; Joly, Camille; Ennezat, Pierre‐Vladimir; Tribouilloy, Christophe; Maréchaux, Sylvestre

doi:10.1016/j.echo.2020.07.002

Cited by 38 publications

(20 citation statements)

References 37 publications

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“…Although post-TAVI change in LVGS and LAGS amounted to only −1.09 and 1.24 percentage points respectively, the importance lies within consistently clinically significant associations between pre-TAVI LAGS, post-TAVI LAGS, and pre-TAVI LVGS and MACE. When we analyzed the association of pre-and post-TAVI LVGS with MACE taking 15% threshold of LVGS as previously reported [41], we did not find statistically significant associations although there was a 2-fold increase in MACE when the pre-TAVI LAGS was <15%. This is consistent with the meta-analysis cited above which found a 2-fold increase in hazards of adverse outcomes for subjects with LVGS<15%.…”

Section: Association Of La Volumes Lags and Lvgs With Adverse Outcomessupporting

confidence: 52%

The Prognostic Value of Left Atrial Global Longitudinal Strain and Left Atrial Phasic Volumes in Patients Undergoing Transcatheter Valve Implantation for Severe Aortic Stenosis

et al. 2021

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Introduction: The changes and the prognostic implications of left atrial (LA) volumes (LAV), LA function, and vascular load in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) are less known. Methods: We enrolled 150 symptomatic patients (mean age 82 ± 8 years, 58% female, and pre-TAVI aortic valve area 0.40 ± 0.19 cm/m2) with severe AS who underwent 2D transthoracic echocardiography and 2D speckle tracking echocardiography at average 21 ± 35 days before and 171 ± 217 days after TAVI. The end point was a composite of new onset of atrial fibrillation, hospitalization for heart failure and all-cause death (major adverse cardiac events [MACE]). Results: After TAVI, indexed maximal LA volume and minimum volume of the LA decreased by 2.1 ± 10 mL/m2 and 1.6 ± 7 mL/m2 (p = 0.032 and p = 0.011, respectively), LA function index increased by 6.8 ± 11 units (p < 0.001), and LA stiffness decreased by 0.38 ± 2.0 (p = 0.05). No other changes in the LA phasic volumes, emptying fractions, and vascular load were noted. Post-TAVI, both left atrial and ventricular global peak longitudinal strain improved by about 6% (p = 0.01 and 0.02, respectively). MACE was reached by 37 (25%) patients after a median follow-up period of 172 days (interquartile range, 20–727). In multivariable models, MACE was associated with both pre- and post-TAVI LA global peak longitudinal strain (hazard ratio [HR] 0.75, CI 0.59–0.97; and HR 0.77, CI 0.60–1.00, per 5 percentage point units, respectively), pre-TAVI LV global endocardial longitudinal strain (HR 1.37, CI 1.02–1.83 per 5 percentage point units), and with most of the LA phasic volumes. Conclusion: Within 6 months after TAVI, there is reverse LA remodeling and an improvement in LA reservoir function. Pre- and post-TAVI indices of LA function and volume remain independently associated with MACE. Larger studies enrolling a greater diversity of patients may provide sufficient evidence for the utilization of these imaging biomarkers in clinical practice.

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Section: Association Of La Volumes Lags and Lvgs With Adverse Outcomessupporting

confidence: 52%

The Prognostic Value of Left Atrial Global Longitudinal Strain and Left Atrial Phasic Volumes in Patients Undergoing Transcatheter Valve Implantation for Severe Aortic Stenosis

et al. 2021

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“…

In the paper ''Prognostic Importance of Left Ventricular Global Longitudinal Strain in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction,'' Thellier et al 1 not only showed that the addition of a cutoff left ventricular (LV) global longitudinal strain (GLS) value of #15% to a multivariate model improved the predictive performance and provided better discrimination for identifying patients with severe aortic stenosis (sAS) and normal LV ejection fraction at increased risk of mortality but also highlighted its unquestionable utility in identifying high-risk sAS patients with no or mild symptoms. 1 These findings fortify the already robust compilation of data supporting the value of GLS in providing a reliable measure of the adaptive remodeling process in sAS. 2 The authors were careful in using a vendor-independent speckle-tracking software to avoid the inherent variability that comes with dissimilar vendor software versions.

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confidence: 56%

“…Lopez-Candales and Vallurupalli for their constructive comments on our paper demonstrating the prognostic importance of global longitudinal strain (GLS) in patients with severe aortic stenosis (AS) and no or only mild symptoms. 1 Indeed, previous reports have clearly demonstrated that increased left ventricular (LV) mass and decreased flow are associated with decreased GLS magnitude, despite a preserved LV ejection fraction (EF). 2,3 This previous finding is not unexpected, as LV longitudinal shortening decreases with increased LV afterload and mass and LV concentric hypertrophy as well as LV longitudinal function per se correlate with decreased LV flow.…”

Section: The Interplay Between Left Ventricular Deformation Flow and Geometry In Aortic Stenosismentioning

confidence: 99%

Better Appreciation of the Mechanical Maladaptive Remodeling in Aortic Stenosis: Imaging in Proper Perspective

López‐Candales

Vallurupalli

2021

Journal of the American Society of Echocardiography

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“…Eventually, a total of nine studies with 1,512 participants were included (12)(13)(14)(15)(16)(17)(18)(19)(20). Table 1 shows the summary of included studies.…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Prognostic Value of Global Longitudinal Strain in Asymptomatic Aortic Stenosis: A Systematic Review and Meta-Analysis

Wang

Zhang

Chen

et al. 2022

Front. Cardiovasc. Med.

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BackgroundsThe presence of impaired global longitudinal strain (GLS) may be a valuable bio-marker in the early diagnosis for left ventricle (LV) impairment, which would help scrutinize asymptomatic aortic stenosis (AS) patients with high risk of adverse outcomes, such as major adverse cardiovascular events (MACE).MethodsThe study was prospectively registered in PROPSERO (CRD 42021223472). Databases, such as Pubmed, Embase, Cochrane Library, Web of science, and Scopus were searched for studies evaluating the impact of impaired GLS on MACE, all-cause mortality, and aortic valve replacement (AVR) in asymptomatic AS. Hazard ratios (HRs) with 95% CIs were calculated with meta-analysis for binary variants. Meta-regression, subgroup analysis, and sensitivity analyses were applied as needed to explore the heterogeneity.ResultsEventually, a total of nine studies reporting 1,512 patients were enrolled. Compared with the normal GLS group, impaired GLS significantly increased MACE (HR = 1.20, 95% CI: 1.10–1.30, I2 = 79%) with evident heterogeneity, all-cause mortality (HR = 1.42, 95% CI: 1.24–1.63), and AVR (HR = 1.17, 95% CI: 1.07–1.28). Subgroup analyses stratified by left ventricular ejection fraction (LVEF) > 50% or LVEF without precise cut-off point found that compared with the normal GLS group, impaired GLS remarkably increased MACE both in two subgroups (LVEF > 50%: HR: 1.22, 95% CI: 1.05–1.50; LVEF without cutpoint: HR: 1.25, 95% CI: 1.05–1.50). The results stratified by AS severity (mild/moderate and severe) or follow-up time resembled those stratified by LVEF. In addition, when subgroup analysis was stratified by mean aortic valve pressure gradient (MG ≥ 40 mm Hg and MG <40 mm Hg), compared with normal GLS, impaired GLS significantly increased MACE both in two subgroups (MG ≥ 40 mm Hg: HR: 3.41, 95% CI: 1.64–7.09; MG below 40 mm Hg: HR: 3.17, 95% CI: 1.87–5.38). Moreover, the effect sizes here were substantially higher than those in the former two stratified factors.ConclusionsThe presence of impaired GLS substantially worsens the outcomes for adverse cardiovascular events in asymptomatic patients with AS regardless of LVEF or AS severity or follow-up time or mean aortic valve pressure gradient, which highlights the importance of incorporating impaired GLS into risk algorithms in asymptomatic AS.Systematic Review RegistrationPROSPERO (registration number: CRD42021223472).

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Prognostic Importance of Left Ventricular Global Longitudinal Strain in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction

Cited by 38 publications

References 37 publications

The Prognostic Value of Left Atrial Global Longitudinal Strain and Left Atrial Phasic Volumes in Patients Undergoing Transcatheter Valve Implantation for Severe Aortic Stenosis

The Prognostic Value of Left Atrial Global Longitudinal Strain and Left Atrial Phasic Volumes in Patients Undergoing Transcatheter Valve Implantation for Severe Aortic Stenosis

Better Appreciation of the Mechanical Maladaptive Remodeling in Aortic Stenosis: Imaging in Proper Perspective

Prognostic Value of Global Longitudinal Strain in Asymptomatic Aortic Stenosis: A Systematic Review and Meta-Analysis

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