Prognostic value of automated longitudinal strain measurements in asymptomatic aortic stenosis

Abstract

ObjectiveTwo-dimensional (2D) longitudinal strain (LS) predicts cardiac events in aortic stenosis (AS). However, it requires manual editing, which affects its accuracy and reliability. We investigated whether left ventricular (LV), left atrial (LA) and right ventricular (RV) LSs using fully automated 2D strain software provide useful prognostic information in asymptomatic AS.MethodsWe performed LS analyses in 340 asymptomatic patients with AS using novel, fully automated 2D strain analytical software (AutoStrain, Philips) to obtain LV global LS (LVGLS), LALS, RV free wall LS and RVLS. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalisation, myocardial infarction or ventricular tachyarrhythmia.ResultsDuring a median of 24 months follow-up, 46 patients reached a primary end point. 62 patients had aortic valve surgery. All four LSs were significantly associated with the primary end point using univariate analysis (HR 0.821 to 0.951, p<0.05). Multivariate analysis revealed that LVGLS (HR 0.873 to 0.888, p<0.05) remained significantly associated with cardiac events, even after adjusting haemodynamic measures of AS severity and LV ejection fraction. Kaplan-Meier survival curve showed median values of both LVGLS (cut-off: 15.1%) and LALS (cut-off: 22.3%) provide a significant difference in cardiac event rate (3-year event-free rate; LVGLS: 89% vs 76%, p=0.002; LALS: 89% vs 76%, p=0.001). Classification and regression-tree analysis, including four LSs, clinical characteristics and traditional echocardiographic parameters, selected LVGLS and E/ε’ for stratifying a high-risk group of patients with cardiac events.ConclusionsFully automated 2D LS analysis, especially LVGLS provides useful prognostic information in asymptomatic AS.

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

“…Thus, GLS has emerged as an accurate and reproducible tool to identify the subclinical LV impairment of AS (5). According to a series of recent studies, identification of reduced longitudinal strain rate caused by the injured subendocardial myocardial fibers had correlations with mortality among asymptomatic patients with AS (12,16,19). However, the prognostic value of GLS in asymptomatic patients with AS has been demonstrated merely in small single-center studies without further confirmation in larger patient populations (12)(13)(14)(15)(16)(17)(18)(19)(20).…”

“…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.…”

“…The cutoff value of GLS associated with MACE was derived from a receiver operating characteristic (ROC) curve analysis in five studies (14-16, 19, 20). Two of the rest used the median value of its sample (12,17). Only two studies chose the clinical cut point (13,18).…”

Automated analysis of limited echocardiograms: Feasibility and relationship to outcomes in COVID-19

“…Notwithstanding the advantages of automated, high-throughput analysis, the benefits of AI driven analysis include savings of time (9,14), improved prognostication (11,15), reduced variability (16), and greater precision (6,13). While the value of automated analysis is increasingly reported, validation of commercially available software with automated capabilities alongside clinical assessment remains limited (9,17,18). As a result, understanding of the capabilities and limitations of automated echocardiographic analysis remains incomplete.…”

Heartbeat: the global burden of atrial fibrillation and ensuring anticoagulation persistence

“…The editorial authors identify a research gap in studies of methods to ensure adherence to OAC therapy and conclude that 'quality research on maintaining persistence is required to guide effective interventions to achieve the full benefit of thrombophylactic therapy in AF, and contribute Another interesting study in this issue of Heart reports the use of automated echocardiographic global longitudinal strain (GLS) analysis in asymptomatic patients with aortic stenosis. 5 In a series of 340 patients followed for a median of 24 months, 46 reached the primary endpoint (a composite of cardiac death, heart failure hospitalisation, myocardial infarction or ventricular tachyarrhythmia) and 62 underwent aortic valve surgery. On multivariate analysis, automated GLS was a significant predictor of cardiac events with a 3-year event free survival of 89% in those with a GLS more than 15.1% compared with 76% in those with a lower GLS (p=0.002).…”