Relation of Myocardial Mechanics in Severe Aortic Stenosis to Left Ventricular Ejection Fraction and Response to Aortic Valve Replacement

Self Cite

Section: Discussionmentioning

confidence: 84%

Section: Clinical Perspective On P 480mentioning

confidence: 99%

Impact of Frequent Nocturnal Hemodialysis on Myocardial Mechanics and Cardiomyocyte Gene Expression

Chan

Arab

Carasso

et al. 2012

Self Cite

“…Both longitudinal strain and strain rate are severely impaired in patients with LFAS, and the extent of impairment of myocardial strain in these patients seems to be more pronounced than what has been previously reported in patients with other cardiac diseases. [6][7][8][9]11,12,16,[29][30][31][32] Assessment of 2-dimensional strain parameters during stress provided significant incremental prognostic information.…”

Section: Discussionmentioning

confidence: 99%

“…Fibrosis develops predominantly in the subendocardial layer in AS, leading to reduced longitudinal function. Carasso et al 32 observed that PLS and PLSR are associated with the degree of myocardial impairment and improve after aortic valve replacement. PLS and PLSR were more severely impaired in present series of patients with LFAS compared with data reported in the literature for various grades of AS severity (PLS: −17.1±3% for mild AS to −14.5±3.9% for severe AS).…”

Section: Two-dimensional Strain Parameters In Lfasmentioning

confidence: 99%

Two-Dimensional Strain for the Assessment of Left Ventricular Function in Low Flow–Low Gradient Aortic Stenosis, Relationship to Hemodynamics, and Outcome

Bartko

Heinze

Graf

et al. 2013

Background-Decision making in patients with low flow-low gradient aortic stenosis mainly depends on the actual stenosis severity and left ventricular function, which is of prognostic importance. We used 2-dimensional strain parameters measured by speckle tracking at rest and during dobutamine stress echocardiography to document the extent of myocardial impairment, its relationship with hemodynamic variables, and its prognostic value. Methods and Results-In 47 patients with low flow-low gradient aortic stenosis, global peak systolic longitudinal strain (PLS) and peak systolic longitudinal strain rate (PLSR) were analyzed. PLS and PLSR at rest and peak stress were −7.56±2.34% and −7.41±2.89% (P=NS) and −0.38±0.12 s −1 and −0.53±0.18 s −1 (P<0.001), respectively. PLS and PLSR inversely correlated with left ventricular ejection fraction at rest (r s =−0.52; P<0.0001 and −0.38; P=0.008) and peak stress (r s =−0.39; P=0.007 and −0.45; P=0.002). The overall 2-year survival rate was 60%. Univariate predictors of survival were peak stress left ventricular ejection fraction (P=0.0026), peak stress PLS (P=0.0002), peak stress PLSR (P<0.0001), and N-terminal pro-B-type natriuretic peptide (P<0.0001). Three hierarchically nested multivariable Cox regression models were constructed-model 1: The Society of Thoracic Surgeons score as an indicator of clinical risk (area under the receiver operating characteristic=0.59); model 2: model 1+N-terminal pro-B-type natriuretic peptide and peak stress left ventricular ejection fraction (area under the receiver operating characteristic=0.83; incremental P<0.0001); model 3: model 2+peak stress PLSR (area under the receiver operating characteristic=0.89; incremental P=0.035). Key Words: aortic stenosis ◼ Doppler echocardiography ◼ heart failure ◼ low flow ◼ myocardial strain ◼ stress echocardiography Conclusions-In

“…7,8 However, the incremental prognostic value of GLS was not well characterized in these studies because of the relatively small sample size. 9,10 In addition, risk-stratification in patients with low-gradient severe AS (paradoxical severe AS) may be clinically challenging, especially as there are limited reports of outcome in these patients.…”

Section: Clinical Perspective On P 945mentioning

confidence: 99%

Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Aortic Stenosis and Preserved Ejection Fraction

Kusunose

Goodman

Parikh

et al. 2014

170

Background— We sought to assess the utility of left ventricular global longitudinal strain (LV-GLS) in predicting mortality in moderate to severe and paradoxical severe aortic stenosis (AS) patients with preserved ejection fraction. Methods and Results— We studied 395 AS patients (70±14 years, 57% men) with aortic valve area <1.3 cm 2 evaluated between January to June 2008 (excluding severe other valve disease and LV ejection fraction <50%). Clinical and echocardiographic data were recorded. LV-GLS was analyzed using Velocity Vector Imaging. AS patients were classified as (a) moderate–severe (n=93; aortic valve area, 1.1–1.3 cm 2 ), (b) standard severe (n=161; aortic valve area, ≤1 cm2; mean gradient ≥40 mm Hg), and (c) paradoxical severe (n=141; aortic valve area, ≤1 cm2 and mean gradient <40 mm Hg). Additive Euroscore was 7±3. The association of LV-GLS with all-cause mortality was assessed after risk-adjustment using Cox proportional hazards models. Median LV-GLS was −14.8% (interquartile range, −17.2%, −12.1%). At 4.4±1.4 years, there were 92 (23%) deaths. On multivariable Cox analysis, additive Euroscore (hazard ratio, 1.19; 1.13–1.27; P <0.001), New York Heart Association class (hazard ratio, 1.44; 1.11–1.87; P <0.001), AV surgery with time-dependent covariate analysis (hazard ratio, 0.29; 0.19–0.45; P <0.001), and LV-GLS (hazard ratio, 1.05; 1.03–1.07; P <0.001) were independent predictors of mortality. LV-GLS <−12.1% (4th quartile) was associated with significantly reduced survival. Addition of LV-GLS to clinical parameters (additive Euroscore+New York Heart Association class) led to significant improvement in prediction of mortality (χ 2 increased from 48 to 58; P <0.01). Conclusions— LV-GLS independently predicts mortality in moderate–severe and severe AS patients with preserved LV ejection fraction, providing incremental prognostic utility, in addition to standard clinical and echocardiographic parameters.