Right ventricular longitudinal strain for risk stratification in low-flow, low-gradient aortic stenosis with low ejection fraction

Dahou, Abdellaziz; Clavel, Marie‐Annick; Capoulade, Romain; Bartko, Philipp E.; Magné, Julien; Mundigler, Gerald; Bergler‐Klein, Jutta; Burwash, Ian G.; Mascherbauer, Julia; Ribeiro, Henrique Barbosa; O’Connor, Kim; Baumgartner, Helmut; Sénéchal, Mario; Dumesnil, Jean G.; Rosenhek, Raphaël; Mathieu, Patrick; Larose, Éric; Rodés‐Cabau, Josep

doi:10.1136/heartjnl-2015-308309

Cited by 40 publications

(29 citation statements)

References 38 publications

(18 reference statements)

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“…More so than baseline LV global longitudinal strain, the presence of flow/contractile reserve, severity of TR, and PH. 27 Our findings were confirmed by the Truly or Pseudo-Severe Aortic Stenosis group, which further demonstrated the prognostic value of RV longitudinal strain at both rest and stress 28 in these patients with reduced LV systolic function.…”

Section: The Impact Of Rv Dysfunction In Patients With Assupporting

confidence: 70%

“…30,31 However, changes in RV systolic function do not seem to be uniform, as worsening of RV systolic function after TAVR, assessed by cardiac magnetic resonance, also has been reported. 32 Advanced imaging methods such as speckle-tracking strain imaging, 28,33 three-dimensional echocardiography, 34 computed tomography, and cardiac magnetic resonance 35 complement 2D echocardiography and invasive hemodynamic testing by providing useful surrogate end points for disease progression and may help track response to interventions for future clinical trials in PH.…”

Section: How To Quantify Rv Systolic Function?mentioning

confidence: 99%

See 1 more Smart Citation

Comprehensive Right-Sided Assessment for Transcatheter Aortic Valve Replacement Risk Stratification: Time for a Change

Cavalcante

Simon

Chan

2017

Journal of the American Society of Echocardiography

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Section: The Impact Of Rv Dysfunction In Patients With Assupporting

confidence: 70%

Section: How To Quantify Rv Systolic Function?mentioning

confidence: 99%

Comprehensive Right-Sided Assessment for Transcatheter Aortic Valve Replacement Risk Stratification: Time for a Change

Cavalcante

Simon

Chan

2017

Journal of the American Society of Echocardiography

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“…Left ventricular longitudinal strain was calculated in standard 4‐, 2‐, and 3‐chamber views as described previously . RVLS strain was assessed in a standard 4‐chamber view as described previously . Strain data are expressed as the percentage of systolic shortening, where negative longitudinal deformation corresponds to shortening (contraction) during systole.…”

Section: Methodsmentioning

confidence: 99%

Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery

Bartko

Wiedemann

Schrutka

et al. 2017

JAHA

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BackgroundExtracorporeal membrane oxygenation following cardiac surgery safeguards end‐organ oxygenation but unfavorably alters cardiac hemodynamics. Along with the detrimental effects of cardiac surgery to the right heart, this might impact outcome, particularly in patients with preexisting right ventricular (RV) dysfunction. We sought to determine the prognostic impact of RV function and to improve established risk‐prediction models in this vulnerable patient cohort.Methods and ResultsOf 240 patients undergoing extracorporeal membrane oxygenation support following cardiac surgery, 111 had echocardiographic examinations at our institution before implantation of extracorporeal membrane oxygenation and were thus included. Median age was 67 years (interquartile range 60‐74), and 74 patients were male. During a median follow‐up of 27 months (interquartile range 16‐63), 75 patients died. Fifty‐one patients died within 30 days, 75 during long‐term follow‐up (median follow‐up 27 months, minimum 5 months, maximum 125 months). Metrics of RV function were the strongest predictors of outcome, even stronger than left ventricular function (P<0.001 for receiver operating characteristics comparisons). Specifically, RV free‐wall strain was a powerful predictor univariately and after adjustment for clinical variables, Simplified Acute Physiology Score‐3, tricuspid regurgitation, surgery type and duration with adjusted hazard ratios of 0.41 (95%CI 0.24‐0.68; P=0.001) for 30‐day mortality and 0.48 (95%CI 0.33‐0.71; P<0.001) for long‐term mortality for a 1‐SD (SD=−6%) change in RV free‐wall strain. Combined assessment of the additive EuroSCORE and RV free‐wall strain improved risk classification by a net reclassification improvement of 57% for 30‐day mortality (P=0.01) and 56% for long‐term mortality (P=0.02) compared with the additive EuroSCORE alone.ConclusionsRV function is strongly linked to mortality, even after adjustment for baseline variables and clinical risk scores. RV performance improves established risk prediction models for short‐ and long‐term mortality.

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“…The role of RV strain is significantly less investigated. In the unique population of patients with low‐flow low‐gradient AS, Dahou et al showed that rest RV longitudinal strain < |13%| was related with worse 2‐year survival, but stress RV longitudinal strain < |14%| (measured during low‐dose dobutamine stress echocardiography) was an even stronger predictor of mortality and provided incremental prognostic value beyond that obtained from the rest RV longitudinal strain.…”

Section: Discussionmentioning

confidence: 99%

Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

Tadić

Cuspidi

Pencic

et al. 2019

J of Clinical Hypertension

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The purpose of this investigation was to evaluate the influence of aortic stenosis (AS) on right ventricular (RV) strain and particularly the importance of arterial hypertension on this association. This cross‐sectional study included 107 patients with moderate and severe AS (with and without hypertension) and preserved left ventricular ejection fraction (>50%) and 82 age‐matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. AS patients were divided into normotensive and hypertensive groups. Left ventricle (LV) mass index gradually increased from the controls, across the moderate AS to the severe AS. There was a trend of reduction of RV global and layer‐specific longitudinal strain of the whole ventricle and RV free wall from the controls, across the moderate AS to the severe AS. RV global longitudinal strain, as well as layer‐specific RV longitudinal strains, was significantly lower in the patients with severe AS than the controls and the normotensive patients with moderate AS. Endocardial and epicardial RV strains were lower in hypertensive than in normotensive patients with moderate AS. In patients with severe AS, there was no difference between normotensive and hypertensive patients. LV mass index and mean aortic valve gradient were associated with RV global longitudinal strain in AS patients independently of systolic blood pressure, LV ejection fraction (EF), age, and body mass index (BMI). In conclusion, RV mechanics was deteriorated in the patients with moderate and severe AS. There was a trend of RV longitudinal strain worsening in the hypertensive patients with AS in comparison with their normotensive counterparts. Severity of AS, expressed by the mean AV gradient, was related with RV longitudinal strain.

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Right ventricular longitudinal strain for risk stratification in low-flow, low-gradient aortic stenosis with low ejection fraction

Abstract: NCT01835028; Results.

Cited by 40 publications

References 38 publications

Comprehensive Right-Sided Assessment for Transcatheter Aortic Valve Replacement Risk Stratification: Time for a Change

Comprehensive Right-Sided Assessment for Transcatheter Aortic Valve Replacement Risk Stratification: Time for a Change

Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery

Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

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