Julien Magne1, Bernard Cosyns2, Bogdan A Popescu3, Helle G Carstensen4, Jordi Dahl5, Milind Y Desai6, Leighton Kearney7, Patrizio Lancellotti8, Thomas H Marwick9, Kimi Sato10, Masaaki Takeuchi11, Concetta Zito12, Anne-Claire Casalta4, Dania Mohty13, Luc Piérard14, Gilbert Habib15, Erwan Donal16. 1. CHU Limoges, Hôpital Dupuytren, Service Cardiologie, INSERM 1094, Limoges, France. Electronic address: julien.magne@unilim.fr. 2. UZ Brussel-CVHZ, Brussels, Belgium. 3. University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu," Bucharest, Romania. 4. Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. 5. Department of Cardiology, Odense University Hospital, Odense, Denmark. 6. Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 7. Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia. 8. University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea, Bari, Italy. 9. Baker Heart and Diabetes Institute, Melbourne, Australia. 10. Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 11. Department of Laboratory and Transfusion Medicine, Hopital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan. 12. Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 13. CHU Limoges, Hôpital Dupuytren, Service Cardiologie, INSERM 1094, Limoges, France. 14. University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU Sart Tilman, Liège, Belgium. 15. Aix-Marseille Université, APHM, La Timone Hospital, Cardiology Department, Marseille, France. 16. Cardiologie et CIC-IT 1414, CHU Rennes; LTSI, Inserm 1099, University Rennes 1, Rennes, France.
Abstract
OBJECTIVES: In this individual participant data meta-analysis on left ventricular global longitudinal strain (LVGLS), our objective was to: 1) describe its distribution; 2) identify the most predictive cutoff values; and 3) assess its impact on mortality in asymptomatic patients with significant aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF). BACKGROUND: The evidence supporting the prognostic role of LVGLS in asymptomatic patients with AS has been obtained from several relatively small studies. METHODS: A literature search was performed for studies published between 2005 and 2017 without language restriction according to the following criteria: "aortic stenosis" AND "longitudinal strain." The corresponding authors of selected studies were contacted and invited to share their data that we computerized in a specific database. The primary endpoint was all-cause mortality. RESULTS: Among the 10 studies included, 1,067 asymptomatic patients with significant AS and LVEF >50% were analyzed. The median of LVGLS was 16.2% (from 5.6% to 30.1%). There were 91 deaths reported during follow-up with median of 1.8 (0.9 to 2.8) years, resulting in a pooled crude mortality rate of 8.5%. The LVGLS performed well in the prediction of death (area under the curve: 0.68). The best cutoff value identified was LVGLS of 14.7% (sensitivity, 60%; specificity, 70%). Using random effects model, the risk of death for patients with LVGLS <14.7% is multiplied by >2.5 (hazard ratio: 2.62; 95% confidence interval: 1.66 to 4.13; p < 0.0001), without significant heterogeneity between studies (I2 = 18.3%; p = 0.275). The relationship between LVGLS and mortality remained significant in patients with LVEF ≥60% (p = 0.001). CONCLUSIONS: This individual participant data meta-analysis demonstrates that in asymptomatic patients with significant AS and normal LVEF, impaired LVGLS is associated with reduced survival. These data emphasize the potential usefulness of LVGLS for risk stratification and management of these patients.
OBJECTIVES: In this individual participant data meta-analysis on left ventricular global longitudinal strain (LVGLS), our objective was to: 1) describe its distribution; 2) identify the most predictive cutoff values; and 3) assess its impact on mortality in asymptomatic patients with significant aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF). BACKGROUND: The evidence supporting the prognostic role of LVGLS in asymptomatic patients with AS has been obtained from several relatively small studies. METHODS: A literature search was performed for studies published between 2005 and 2017 without language restriction according to the following criteria: "aortic stenosis" AND "longitudinal strain." The corresponding authors of selected studies were contacted and invited to share their data that we computerized in a specific database. The primary endpoint was all-cause mortality. RESULTS: Among the 10 studies included, 1,067 asymptomatic patients with significant AS and LVEF >50% were analyzed. The median of LVGLS was 16.2% (from 5.6% to 30.1%). There were 91 deaths reported during follow-up with median of 1.8 (0.9 to 2.8) years, resulting in a pooled crude mortality rate of 8.5%. The LVGLS performed well in the prediction of death (area under the curve: 0.68). The best cutoff value identified was LVGLS of 14.7% (sensitivity, 60%; specificity, 70%). Using random effects model, the risk of death for patients with LVGLS <14.7% is multiplied by >2.5 (hazard ratio: 2.62; 95% confidence interval: 1.66 to 4.13; p < 0.0001), without significant heterogeneity between studies (I2 = 18.3%; p = 0.275). The relationship between LVGLS and mortality remained significant in patients with LVEF ≥60% (p = 0.001). CONCLUSIONS: This individual participant data meta-analysis demonstrates that in asymptomatic patients with significant AS and normal LVEF, impaired LVGLS is associated with reduced survival. These data emphasize the potential usefulness of LVGLS for risk stratification and management of these patients.
Authors: Olga Vriz; Paolo Palatini; Lucio Mos; Hani AlSergani; Igor Vendramin; Ugolino Livi; Francesco Antonini-Canterin; Julien Magne Journal: Int J Cardiovasc Imaging Date: 2021-03-13 Impact factor: 2.357
Authors: Gilberto J Aquino; Josua A Decker; U Joseph Schoepf; Landin Carson; Namrata Paladugu; Basel Yacoub; Verena Brandt; Anna Lena Emrich; Florian Schwarz; Jeremy R Burt; Richard Bayer; Akos Varga-Szemes; Tilman Emrich Journal: Radiol Cardiothorac Imaging Date: 2022-06-30
Authors: Tom Kai Ming Wang; Milind Y Desai; Patrick Collier; Richard A Grimm; Brian P Griffin; Zoran B Popović Journal: Cardiovasc Diagn Ther Date: 2020-12
Authors: Aleksandra Budkiewicz; Michał A Surdacki; Aleksandra Gamrat; Katarzyna Trojanowicz; Andrzej Surdacki; Bernadeta Chyrchel Journal: J Clin Med Date: 2021-05-27 Impact factor: 4.241
Authors: Remy Merkx; Jan M Leerink; Elisabeth Lieke A M Feijen; Leontien C M Kremer; Esmée C de Baat; Louise Bellersen; Elvira C van Dalen; Eline van Dulmen-den Broeder; Margriet van der Heiden-van der Loo; Marry M van den Heuvel-Eibrink; Chris L de Korte; Jacqueline Loonen; Marloes Louwerens; Angela H E M Maas; Yigal M Pinto; Cécile M Ronckers; Arco J Teske; Wim J E Tissing; Andrica C H de Vries; Annelies M C Mavinkurve-Groothuis; Helena J H van der Pal; Gert Weijers; Wouter E M Kok; Livia Kapusta Journal: Echocardiography Date: 2021-05-20 Impact factor: 1.724
Authors: Andreea Calin; Anca D Mateescu; Andreea C Popescu; Rong Bing; Marc R Dweck; Bogdan A Popescu Journal: Heart Date: 2020-03-16 Impact factor: 5.994