Usefulness of global left ventricular longitudinal strain for risk stratification in low ejection fraction, low-gradient aortic stenosis: results from the multicenter True or Pseudo-Severe Aortic Stenosis study.

Abstract

BACKGROUND:

The objective of this study was to examine the impact of left ventricular (LV) global longitudinal strain (GLS) measured at rest and at dobutamine stress echocardiography on the outcome of patients with low LV ejection fraction and low-gradient aortic stenosis.

METHODS AND RESULTS:

Among the 202 patients with low LV ejection fraction (≤40%), low-gradient aortic stenosis (mean transvalvular gradient <40 mm Hg and indexed aortic valve area ≤0.6 cm(2)/m(2)) prospectively enrolled in the multicenter True or Pseudo-Severe Aortic Stenosis study, 126 patients with resting GLS and 73 patients with stress GLS available were included in this substudy. Three-year survival rate was 49% in patients with rest GLS <|9|% compared with 68% in patients with GLS >|9|% (P=0.02). In a multivariable Cox model adjusted for age, coronary artery disease, projected aortic valve area at a normal flow rate and type of treatment (aortic valve replacement versus conservative), rest GLS <|9|% (hazard ratio, 2.18; P=0.015) remained independently associated with all-cause mortality. GLS <|10|% measured during dobutamine stress echocardiography was also independently associated with mortality (hazard ratio, 2.67; P=0.01). In the subset of patients with stress GLS (n=73), the χ(2) of the multivariable model to predict all-causes mortality was 21.96 for stress GLS versus 17.78 for rest GLS.

CONCLUSIONS:

GLS is independently associated with mortality in patients with low LV ejection fraction, low-gradient aortic stenosis. Stress GLS measured during dobutamine stress echocardiography may provide incremental prognostic value beyond GLS measured at rest. Hence, measurement of GLS at rest and during dobutamine stress echocardiography may be helpful to enhance risk stratification in low LV ejection fraction, low-gradient aortic stenosis.

CLINICAL TRIAL REGISTRATION URL:

http://www.clinicaltrials.gov. Unique identifier: NCT01835028.

• Authors: Abdellaziz Dahou, Philipp Emanuel Bartko, Romain Capoulade, Marie-Annick Clavel, Gerald Mundigler, Samuel Larue Grondin, Jutta Bergler-Klein, Ian Burwash, Jean G Dumesnil, Mario Sénéchal, Kim O'Connor, Helmut Baumgartner, Philippe Pibarot
• Journal: Circulation. Cardiovascular imaging (Circ Cardiovasc Imaging) Vol. 8 Issue 3 Pg. e002117 (Mar 2015) ISSN: 1942-0080 [Electronic] United States
• PMID: 25681417 (Publication Type: Evaluation Study, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 American Heart Association, Inc.

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (physiopathology)
• Aortic Valve Stenosis (diagnostic imaging, mortality, physiopathology)
• Chi-Square Distribution
• Echocardiography, Doppler, Pulsed
• Echocardiography, Stress
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Stroke Volume
• Time Factors
• Ventricular Dysfunction, Left (diagnostic imaging, mortality, physiopathology)
• Ventricular Function, Left