Erwan Salaun1,2, Anne-Claire Casalta1,2, Erwan Donal3, Yohann Bohbot4, Elena Galli3, Christophe Tribouilloy4, Sandrine Hubert2, Julien Magne5, Julien Mancini6,7, Sebastien Renard2, Jean-Francois Avierinos2, Laurie-Anne Maysou2, Cécile Lavoute1,2, Catherine Szymanski4, Julie Haentjens1,2, Gilbert Habib1,2. 1. Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Aix Marseille Université - UM 63, CNRS 7278, IRD 198, INSERM 1095, 27 Boulevard Jean Moulin, 13385 Cedex 5, Marseille, France. 2. Cardiology Department, APHM, La Timone Hospital, Marseille 13005, France. 3. Cardiology department & CIC-IT 1414, hôpital Pontchaillou, university hospital of Rennes, 35033 Rennes, France. 4. Cardiology department, university hospital of Amiens, avenue René-Laënnec, 80054 Amiens cedex 1, France. 5. CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France. 6. Aix-Marseille Université, Inserm, IRD, UMR912, SESSTIM, Marseille F-13273, France. 7. Public Health Department (BIOSTIC), APHM, Timone Hospital, Marseille F-13385, France.
Abstract
Aims: To evaluate the prognostic value of apical four-chamber (A4-C) longitudinal strain (LS) in patients with aortic stenosis (AS). Methods and results: In a multicentre cohort, 582 patients (74.3 ± 10.9 years) with moderate or severe AS and preserved left ventricular (LV) ejection fraction (≥50%) were included in this retrospective study. Patients with severe AS were classified in four subgroups according to flow and gradient: low flow (LF) was defined as a stroke volume index <35 mL/m2 compared with normal flow (NF); low-gradient (LG) as a mean gradient <40 mmHg compared with high gradient (HG). The end point was all-cause of mortality. A4-C LS was measured by two-dimensional speckle tracking and was feasible in all patients. The degree of A4-C LV longitudinal dysfunction increased according to the severity and subgroups of severe AS: from the least to the most impaired: moderate AS, NF/HG, NF/LG, LF/HG, and LF/LG AS (P < 0.001). During a mean follow-up of 2.6 ± 0.2 years, 58(10%) patients died. The 2-year survival was 76.8% in patients with LF/LG vs. 89.3% in patients with other groups. The best threshold of A4-C LS associated with overall mortality was an absolute cut-off value of |13.75%|. According to this cut-off, the 2-year survival was higher both in patients with moderate AS (96.3 vs. 70%, P = 0.02) and those with severe AS (92.9 vs. 80.9%, P = 0.005). However when dichotomized according to flow/gradient patterns, the association was only statistically significant in the subgroup of patients with NF/HG. By multivariable cox regression analysis, A4-C LS <|13.75| remained independently associated with overall mortality (hazard ratio: 1.8; P = 0.045). Conclusion: A4-C LS is independently associated with death in patients with AS and preserved LVEF, however the flow/gradient pattern should also be considered as an important parameter. The management of these patients may use A4-C LS as a new parameter of evaluation of LV function and prognosis.
Aims: To evaluate the prognostic value of apical four-chamber (A4-C) longitudinal strain (LS) in patients with aortic stenosis (AS). Methods and results: In a multicentre cohort, 582 patients (74.3 ± 10.9 years) with moderate or severe AS and preserved left ventricular (LV) ejection fraction (≥50%) were included in this retrospective study. Patients with severe AS were classified in four subgroups according to flow and gradient: low flow (LF) was defined as a stroke volume index <35 mL/m2 compared with normal flow (NF); low-gradient (LG) as a mean gradient <40 mmHg compared with high gradient (HG). The end point was all-cause of mortality. A4-C LS was measured by two-dimensional speckle tracking and was feasible in all patients. The degree of A4-C LV longitudinal dysfunction increased according to the severity and subgroups of severe AS: from the least to the most impaired: moderate AS, NF/HG, NF/LG, LF/HG, and LF/LG AS (P < 0.001). During a mean follow-up of 2.6 ± 0.2 years, 58(10%) patients died. The 2-year survival was 76.8% in patients with LF/LG vs. 89.3% in patients with other groups. The best threshold of A4-C LS associated with overall mortality was an absolute cut-off value of |13.75%|. According to this cut-off, the 2-year survival was higher both in patients with moderate AS (96.3 vs. 70%, P = 0.02) and those with severe AS (92.9 vs. 80.9%, P = 0.005). However when dichotomized according to flow/gradient patterns, the association was only statistically significant in the subgroup of patients with NF/HG. By multivariable cox regression analysis, A4-C LS <|13.75| remained independently associated with overall mortality (hazard ratio: 1.8; P = 0.045). Conclusion: A4-C LS is independently associated with death in patients with AS and preserved LVEF, however the flow/gradient pattern should also be considered as an important parameter. The management of these patients may use A4-C LS as a new parameter of evaluation of LV function and prognosis.
Authors: Gabriella Bufano; Francesco Radico; Carolina D'Angelo; Francesca Pierfelice; Maria Vittoria De Angelis; Massimiliano Faustino; Sante Donato Pierdomenico; Sabina Gallina; Giulia Renda Journal: Front Cardiovasc Med Date: 2022-04-25
Authors: Jakob Park; Yekaterina Kim; Jason Pereira; Kerrilynn C Hennessey; Kamil F Faridi; Robert L McNamara; Eric J Velazquez; David J Hur; Lissa Sugeng; Vratika Agarwal Journal: Am Heart J Plus Date: 2021-06-01