Prognostic Value of Global Longitudinal Strain in Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis With Preserved Ejection Fraction

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Author(s)

    • Sato Kimi Sato Kimi
    • Cardiovascular Division, Graduate School of Comprehensive Human Sciences, University of Tsukuba
    • Takeuchi Masaaki
    • Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
    • Izumo Masaki
    • Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
    • Suzuki Kengo
    • Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
    • Yamashita Eiji
    • Division of Cardiology, Gunma Prefectural Cardiovascular Center
    • Oshima Shigeru
    • Division of Cardiology, Gunma Prefectural Cardiovascular Center
    • Akashi Yoshihiro J.
    • Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine

Abstract

<b><i>Background:</i></b>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).<b><i>Methods and Results:</i></b>We enrolled 204 patients with severe AS (indexed aortic valve area [iAVA] <0.6 cm<sup>2</sup>/m<sup>2</sup>) 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<sup>2</sup>) 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.<b><i>Conclusions:</i></b>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. (<i>Circ J</i> 2014; <b>78:</b> 2750–2759)

Journal

  • Circulation Journal

    Circulation Journal 78(11), 2750-2759, 2014

    The Japanese Circulation Society

Codes

  • NII Article ID (NAID)
    130004693850
  • NII NACSIS-CAT ID (NCID)
    AA11591968
  • Text Lang
    ENG
  • ISSN
    1346-9843
  • NDL Article ID
    025863097
  • NDL Call No.
    Z54-B860
  • Data Source
    NDL  J-STAGE 
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