Yasufumi Nagata1, Masaaki Takeuchi2, Victor Chien-Chia Wu3, Masaki Izumo4, Kengo Suzuki4, Kimi Sato5, Yoshihiro Seo5, Yoshihiro J Akashi4, Kazutaka Aonuma5, Yutaka Otsuji1. 1. Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. 2. Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. Electronic address: takeuchi@med.uoeh-u.ac.jp. 3. Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan; Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan. 4. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. 5. Cardiovascular Division, University of Tsukuba, Tsukuba, Japan.
Abstract
OBJECTIVES: The objective of this study was to determine which strain component assessed by 2-dimensional speckle-tracking echocardiography (2DSTE) and 3-dimensional speckle-tracking echocardiography (3DSTE) was the most powerful predictor for future major adverse cardiac events (MACE) in asymptomatic patients with severe aortic stenosis (AS). BACKGROUND: Ongoing debate exists regarding the appropriateness of early surgery in asymptomatic severe AS and preserved left ventricular ejection fraction (LVEF). Previous studies showed that 2-dimensional global longitudinal strain (2DGLS) was a significant predictor in asymptomatic severe AS patients. However, the prognostic utility of 3DSTE-derived multidirectional strain parameters has not been investigated in these patients. METHODS: We enrolled 104 asymptomatic severe AS patients (indexed aortic valve area <0.6 cm(2)/m(2)) and preserved LVEF and performed strain analysis using both 2DSTE and 3DSTE. Two-dimensional and 3-dimensional global longitudinal, circumferential, and radial strain and global 3-dimensional strain were measured in each patient. All patients were followed to record MACE. RESULTS: During a median follow-up of 373 days, MACE developed in 33 patients (32%). 2DGLS (-14.7 ± 3.3 vs. -16.3 ± 3.3, p = 0.0168), 3DGLS (-13.5 ± 2.5 vs. -16.1 ± 2.4, p < 0.0001) and 3-dimensional global radial strain (3DGRS) (35.9 ± 4.5 vs. 38.1 ± 4.4, p = 0.0209) were significantly impaired in patients with MACE compared with those without MACE. Kaplan-Meier analysis showed 2DGLS (cutoff: -17.0%), 3DGLS (cutoff: -14.5%), and 3DGRS (cutoff: 39.0%) provide a significant difference in MACE rate. Receiver-operating characteristic analysis revealed that the area under the curve of 3DGLS for MACE (0.78) was significantly larger than that of 2DGLS (0.62, p = 0.0044) and 3DGRS (0.66, p = 0.0069). Separate multivariate analysis revealed 3DGLS was only significant as independent predictor for future MACE after correcting for mean pressure gradient and left ventricular mass index. CONCLUSIONS: 3DGLS is the most robust index for predicting future adverse cardiac events in asymptomatic severe AS patients with preserved LVEF.
OBJECTIVES: The objective of this study was to determine which strain component assessed by 2-dimensional speckle-tracking echocardiography (2DSTE) and 3-dimensional speckle-tracking echocardiography (3DSTE) was the most powerful predictor for future major adverse cardiac events (MACE) in asymptomatic patients with severe aortic stenosis (AS). BACKGROUND: Ongoing debate exists regarding the appropriateness of early surgery in asymptomatic severe AS and preserved left ventricular ejection fraction (LVEF). Previous studies showed that 2-dimensional global longitudinal strain (2DGLS) was a significant predictor in asymptomatic severe AS patients. However, the prognostic utility of 3DSTE-derived multidirectional strain parameters has not been investigated in these patients. METHODS: We enrolled 104 asymptomatic severe AS patients (indexed aortic valve area <0.6 cm(2)/m(2)) and preserved LVEF and performed strain analysis using both 2DSTE and 3DSTE. Two-dimensional and 3-dimensional global longitudinal, circumferential, and radial strain and global 3-dimensional strain were measured in each patient. All patients were followed to record MACE. RESULTS: During a median follow-up of 373 days, MACE developed in 33 patients (32%). 2DGLS (-14.7 ± 3.3 vs. -16.3 ± 3.3, p = 0.0168), 3DGLS (-13.5 ± 2.5 vs. -16.1 ± 2.4, p < 0.0001) and 3-dimensional global radial strain (3DGRS) (35.9 ± 4.5 vs. 38.1 ± 4.4, p = 0.0209) were significantly impaired in patients with MACE compared with those without MACE. Kaplan-Meier analysis showed 2DGLS (cutoff: -17.0%), 3DGLS (cutoff: -14.5%), and 3DGRS (cutoff: 39.0%) provide a significant difference in MACE rate. Receiver-operating characteristic analysis revealed that the area under the curve of 3DGLS for MACE (0.78) was significantly larger than that of 2DGLS (0.62, p = 0.0044) and 3DGRS (0.66, p = 0.0069). Separate multivariate analysis revealed 3DGLS was only significant as independent predictor for future MACE after correcting for mean pressure gradient and left ventricular mass index. CONCLUSIONS: 3DGLS is the most robust index for predicting future adverse cardiac events in asymptomatic severe AS patients with preserved LVEF.
Authors: Kan Zhang; Richard Sheu; Nicole M Zimmerman; Andrej Alfirevic; Shiva Sale; A Marc Gillinov; Andra E Duncan Journal: J Cardiothorac Vasc Anesth Date: 2018-10-24 Impact factor: 2.628
Authors: E Mara Vollema; Tadafumi Sugimoto; Mylène Shen; Lionel Tastet; Arnold C T Ng; Rachid Abou; Nina Ajmone Marsan; Bart Mertens; Raluca Dulgheru; Patrizio Lancellotti; Marie-Annick Clavel; Philippe Pibarot; Philippe Genereux; Martin B Leon; Victoria Delgado; Jeroen J Bax Journal: JAMA Cardiol Date: 2018-09-01 Impact factor: 14.676
Authors: Diego Medvedofsky; Francesco Maffessanti; Lynn Weinert; David M Tehrani; Akhil Narang; Karima Addetia; Anuj Mediratta; Stephanie A Besser; Elad Maor; Amit R Patel; Kirk T Spencer; Victor Mor-Avi; Roberto M Lang Journal: JACC Cardiovasc Imaging Date: 2017-11-15