Prognostic value of global longitudinal strain in paradoxical low-flow, low-gradient severe aortic stenosis with...

To assess whether global longitudinal strain (GLS) can discriminate high-risk patients with adverse outcome in paradoxical low-flow, low-gradient (LFLPG) severe aortic stenosis (AS). METHODS AND RESULTS: We enrolled 204 patients with severe AS (indexed aortic valve area [iAVA] <0.6 cm(2)/m(2)) and preserved left ventricular ejection fraction (LVEF >50%). Patients were divided into 4 groups according to flow state (stroke volume index < or > 35 ml/m(2)) and mean pressure gradient (< or > 40 mmHg). LV GLS was measured by 2-dimensional speckle-tracking analysis. The primary endpoint consisted of major cardiovascular events, including aortic valve replacement. During a mean 399-day follow-up, 51 (25%) patients met the primary endpoint. Among the 98 LFLPG AS patients, GLS was significantly reduced in patients with any event (-15.6±4.5% vs. -19.4±3.6%, P=0.002). Using receiver-operating characteristic analysis, we classified LFLPG AS patients as impaired GLS (GLS ≥-17%, n=24) or preserved GLS (GLS <-17%, n=74). The impaired GLS group had smaller iAVA, higher LV mass index, higher E/E', and lower overall 2-year event-free survival (57% vs. 97%; P<0.001) than the preserved GLS group.

Longitudinal function was severely impaired in patients with LFLPG AS and they had poor prognosis. GLS could stratify the high-risk group for future adverse outcomes. Patients with paradoxical LFLPG AS comprised a mixed group with different LV mechanical properties associated with different prognoses.