E Mara Vollema1, Mohammed R Amanullah2, Edgard A Prihadi1, Arnold C T Ng3, Pieter van der Bijl1, Yoong Kong Sin4, Nina Ajmone Marsan1, Zee Pin Ding2, Philippe Généreux5,6,7, Martin B Leon5,8, See Hooi Ewe2, Victoria Delgado1, Jeroen J Bax1. 1. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 2. Department of Cardiology, National Heart Centre Singapore, Singapore. 3. Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia. 4. Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore. 5. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. 6. Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA. 7. Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada. 8. New York-Presbyterian Hospital/Columbia University, Medical Center, New York, NY, USA.
Abstract
AIMS: Cardiac damage in severe aortic stenosis (AS) can be classified according to a recently proposed staging classification. The present study investigated the incremental prognostic value of left ventricular (LV) global longitudinal strain (GLS) over stages of cardiac damage in patients with severe AS. METHODS AND RESULTS: From an ongoing registry, a total of 616 severe symptomatic AS patients with available LV GLS by speckle tracking echocardiography were selected and retrospectively analysed. Patients were categorized according to cardiac damage on echocardiography: Stage 0 (no damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). LV GLS was divided by quintiles and assigned to the different stages. The endpoint was all-cause mortality. Over a median follow-up of 44 [24-89] months, 234 (38%) patients died. LV GLS was associated with all-cause mortality independent of stage of cardiac damage. After incorporation of LV GLS by quintiles into the staging classification, Stages 2-4 were independently associated with outcome. LV GLS showed incremental prognostic value over clinical characteristics and stages of cardiac damage. CONCLUSION: In this large single-centre cohort of severe AS patients, incorporation of LV GLS by quintiles in a novel proposed staging classification resulted in refinement of risk stratification by identifying patients with more advanced cardiac damage. LV GLS was shown to provide incremental prognostic value over the originally proposed staging classification. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Cardiac damage in severe aortic stenosis (AS) can be classified according to a recently proposed staging classification. The present study investigated the incremental prognostic value of left ventricular (LV) global longitudinal strain (GLS) over stages of cardiac damage in patients with severe AS. METHODS AND RESULTS: From an ongoing registry, a total of 616 severe symptomatic AS patients with available LV GLS by speckle tracking echocardiography were selected and retrospectively analysed. Patients were categorized according to cardiac damage on echocardiography: Stage 0 (no damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). LV GLS was divided by quintiles and assigned to the different stages. The endpoint was all-cause mortality. Over a median follow-up of 44 [24-89] months, 234 (38%) patientsdied. LV GLS was associated with all-cause mortality independent of stage of cardiac damage. After incorporation of LV GLS by quintiles into the staging classification, Stages 2-4 were independently associated with outcome. LV GLS showed incremental prognostic value over clinical characteristics and stages of cardiac damage. CONCLUSION: In this large single-centre cohort of severe AS patients, incorporation of LV GLS by quintiles in a novel proposed staging classification resulted in refinement of risk stratification by identifying patients with more advanced cardiac damage. LV GLS was shown to provide incremental prognostic value over the originally proposed staging classification. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Taishi Okuno; Dik Heg; Jonas Lanz; Stefan Stortecky; Fabien Praz; Stephan Windecker; Thomas Pilgrim Journal: Int J Cardiol Heart Vasc Date: 2021-04-01
Authors: Adil Wani; Daniel R Harland; Tanvir K Bajwa; Stacie Kroboth; Khawaja Afzal Ammar; Suhail Q Allaqaband; Sue Duval; Bijoy K Khandheria; A Jamil Tajik; Renuka Jain Journal: Front Cardiovasc Med Date: 2022-01-17