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Basal longitudinal strain predicts future aortic valve replacement in asymptomatic patients with aortic stenosis

Helle Gervig Carstensen1, Linnea Hornbech Larsen2, Christian Hassager2

  • 1Department of Cardiology, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, DK-2900 Copenhagen, Denmark hellegervig@hotmail.com.

European Heart Journal. Cardiovascular Imaging
|June 16, 2015
PubMed

Insights

Reduced basal longitudinal strain (BLS) predicts the need for aortic valve replacement (AVR) in asymptomatic aortic stenosis patients, even when considering coronary artery disease. Global longitudinal strain (GLS) did not show the same predictive power.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiac Imaging

Background:

  • Global longitudinal strain (GLS) and basal longitudinal strain (BLS) are established markers of myocardial dysfunction and prognostic indicators in asymptomatic aortic stenosis.
  • Aortic stenosis and ischemic heart disease share common risk factors, potentially confounding the assessment of longitudinal function in patients with aortic stenosis due to silent coronary pathology.

Purpose of the Study:

  • To determine the prognostic value of GLS and BLS in asymptomatic aortic stenosis patients.
  • To assess the predictive capability of GLS and BLS in relation to coexisting coronary pathology identified by multi-detector computed tomography (MDCT) coronary angiography.

Main Methods:

  • Prospective follow-up of 104 asymptomatic patients with moderate-to-severe aortic stenosis (aortic valve area <1.5 cm²).
  • Comprehensive clinical evaluation, advanced echocardiographic analysis, and MDCT coronary angiography were performed.
  • The primary endpoint was the indication for aortic valve replacement (AVR) or sudden cardiac death.

Main Results:

  • During a median follow-up of 2.3 years, 41% of patients met the endpoint for AVR.
  • Basal and mid-ventricular segments showed significantly reduced strain in patients who underwent AVR, with apical segments spared.
  • Multivariable Cox regression analysis identified BLS, but not GLS, as an independent predictor of AVR.

Conclusions:

  • Reduced basal longitudinal strain (BLS) is a significant independent predictor of future aortic valve replacement (AVR) in asymptomatic aortic stenosis patients.
  • This predictive value of BLS remains significant irrespective of clinical factors, conventional echocardiographic measures, and coronary pathology.
Abstract

Keywords:
Aortic valve replacementAsymptomatic aortic stenosisRegional strainTwo-dimensional speckle tracking

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