Association of left ventricular global longitudinal strain with asymptomatic severe aortic stenosis natural course and prognostic value

E. Mara Vollema, Tadafumi Sugimoto, Mylène Shen, Lionel Tastet, Arnold C.T. Ng, Rachid Abou, Nina Ajmone Marsan, Bart Mertens, Raluca Dulgheru, Patrizio Lancellotti, Marie Annick Clavel, Philippe Pibarot, Philippe Genereux, Martin B. Leon, Victoria Delgado, Jeroen J. Bax

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

IMPORTANCE The optimal timing to operate in patients with asymptomatic severe aortic stenosis (AS) remains controversial. Left ventricular global longitudinal strain (LV GLS) may help to identify patients who might benefit from undergoing earlier aortic valve replacement. OBJECTIVE To investigate the prevalence of impaired LV GLS, the natural course of LV GLS, and its prognostic implications in patients with asymptomatic severe AS with preserved left ventricular ejection fraction (LVEF). DESIGN, SETTING, AND PARTICIPANTS This registry-based study included the institutional registries of 3 large tertiary referral centers and 220 patients with asymptomatic severe AS and preserved LVEF (>50%) who were matched for age and sex with 220 controls without structural heart disease. The echocardiograms of patients and controls were performed between 1998 and 2017. EXPOSURES Both clinical and echocardiographic data were assessed retrospectively. Severe AS was defined by an indexed aortic valve area less than 0.6 cm2/m2. Left ventricular global longitudinal strain was evaluated on transthoracic echocardiography using speckle tracking imaging. MAIN OUTCOMES AND MEASURES The prevalence of impaired LV GLS, the natural course of LV GLS, and the association of impaired LV GLS with symptom onset and the need for aortic valve intervention. RESULTS Two hundred twenty patients (mean [SD] age, 68 [13] years; 126 men [57%]) were included. Despite comparable LVEF, LV GLS was significantly impaired in patients with asymptomatic severe AS compared with age- and sex-matched controls without AS (mean [SD] LV GLS, -17.9% [2.5%] vs -19.6%[2.1%]; P < .001). After a median follow-up of 12 (interquartile range, 7-23) months, mean (SD) LV GLS significantly deteriorated (-18.0% [2.6%] to -16.3%[2.8%]; P < .001) while LVEF remained unchanged. Patients with impaired LV GLS at baseline (>-18.2%) showed a higher risk for developing symptoms (P = .02) and needing aortic valve intervention (P = .03) at follow-up compared with patients with more preserved LV GLS (≤-18.2%). CONCLUSIONS AND RELEVANCE Subclinicalmyocardial dysfunction that is characterized by impaired LV GLS is often present in patients with asymptomatic severe AS with preserved LVEF. Left ventricular global longitudinal strain further deteriorates over time and impaired LV GLS at baseline is associated with an increased risk for progression to the symptomatic stage and the need for aortic valve intervention.

Original languageEnglish (US)
Pages (from-to)839-847
Number of pages9
JournalJAMA Cardiology
Volume3
Issue number9
DOIs
StatePublished - Sep 2018

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Aortic Valve Stenosis
Aortic Valve
Stroke Volume
Registries
Tertiary Care Centers
Echocardiography
Heart Diseases

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Vollema, E. Mara ; Sugimoto, Tadafumi ; Shen, Mylène ; Tastet, Lionel ; Ng, Arnold C.T. ; Abou, Rachid ; Marsan, Nina Ajmone ; Mertens, Bart ; Dulgheru, Raluca ; Lancellotti, Patrizio ; Clavel, Marie Annick ; Pibarot, Philippe ; Genereux, Philippe ; Leon, Martin B. ; Delgado, Victoria ; Bax, Jeroen J. / Association of left ventricular global longitudinal strain with asymptomatic severe aortic stenosis natural course and prognostic value. In: JAMA Cardiology. 2018 ; Vol. 3, No. 9. pp. 839-847.
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title = "Association of left ventricular global longitudinal strain with asymptomatic severe aortic stenosis natural course and prognostic value",
abstract = "IMPORTANCE The optimal timing to operate in patients with asymptomatic severe aortic stenosis (AS) remains controversial. Left ventricular global longitudinal strain (LV GLS) may help to identify patients who might benefit from undergoing earlier aortic valve replacement. OBJECTIVE To investigate the prevalence of impaired LV GLS, the natural course of LV GLS, and its prognostic implications in patients with asymptomatic severe AS with preserved left ventricular ejection fraction (LVEF). DESIGN, SETTING, AND PARTICIPANTS This registry-based study included the institutional registries of 3 large tertiary referral centers and 220 patients with asymptomatic severe AS and preserved LVEF (>50{\%}) who were matched for age and sex with 220 controls without structural heart disease. The echocardiograms of patients and controls were performed between 1998 and 2017. EXPOSURES Both clinical and echocardiographic data were assessed retrospectively. Severe AS was defined by an indexed aortic valve area less than 0.6 cm2/m2. Left ventricular global longitudinal strain was evaluated on transthoracic echocardiography using speckle tracking imaging. MAIN OUTCOMES AND MEASURES The prevalence of impaired LV GLS, the natural course of LV GLS, and the association of impaired LV GLS with symptom onset and the need for aortic valve intervention. RESULTS Two hundred twenty patients (mean [SD] age, 68 [13] years; 126 men [57{\%}]) were included. Despite comparable LVEF, LV GLS was significantly impaired in patients with asymptomatic severe AS compared with age- and sex-matched controls without AS (mean [SD] LV GLS, -17.9{\%} [2.5{\%}] vs -19.6{\%}[2.1{\%}]; P < .001). After a median follow-up of 12 (interquartile range, 7-23) months, mean (SD) LV GLS significantly deteriorated (-18.0{\%} [2.6{\%}] to -16.3{\%}[2.8{\%}]; P < .001) while LVEF remained unchanged. Patients with impaired LV GLS at baseline (>-18.2{\%}) showed a higher risk for developing symptoms (P = .02) and needing aortic valve intervention (P = .03) at follow-up compared with patients with more preserved LV GLS (≤-18.2{\%}). CONCLUSIONS AND RELEVANCE Subclinicalmyocardial dysfunction that is characterized by impaired LV GLS is often present in patients with asymptomatic severe AS with preserved LVEF. Left ventricular global longitudinal strain further deteriorates over time and impaired LV GLS at baseline is associated with an increased risk for progression to the symptomatic stage and the need for aortic valve intervention.",
author = "Vollema, {E. Mara} and Tadafumi Sugimoto and Myl{\`e}ne Shen and Lionel Tastet and Ng, {Arnold C.T.} and Rachid Abou and Marsan, {Nina Ajmone} and Bart Mertens and Raluca Dulgheru and Patrizio Lancellotti and Clavel, {Marie Annick} and Philippe Pibarot and Philippe Genereux and Leon, {Martin B.} and Victoria Delgado and Bax, {Jeroen J.}",
year = "2018",
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doi = "10.1001/jamacardio.2018.2288",
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Vollema, EM, Sugimoto, T, Shen, M, Tastet, L, Ng, ACT, Abou, R, Marsan, NA, Mertens, B, Dulgheru, R, Lancellotti, P, Clavel, MA, Pibarot, P, Genereux, P, Leon, MB, Delgado, V & Bax, JJ 2018, 'Association of left ventricular global longitudinal strain with asymptomatic severe aortic stenosis natural course and prognostic value', JAMA Cardiology, vol. 3, no. 9, pp. 839-847. https://doi.org/10.1001/jamacardio.2018.2288

Association of left ventricular global longitudinal strain with asymptomatic severe aortic stenosis natural course and prognostic value. / Vollema, E. Mara; Sugimoto, Tadafumi; Shen, Mylène; Tastet, Lionel; Ng, Arnold C.T.; Abou, Rachid; Marsan, Nina Ajmone; Mertens, Bart; Dulgheru, Raluca; Lancellotti, Patrizio; Clavel, Marie Annick; Pibarot, Philippe; Genereux, Philippe; Leon, Martin B.; Delgado, Victoria; Bax, Jeroen J.

In: JAMA Cardiology, Vol. 3, No. 9, 09.2018, p. 839-847.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of left ventricular global longitudinal strain with asymptomatic severe aortic stenosis natural course and prognostic value

AU - Vollema, E. Mara

AU - Sugimoto, Tadafumi

AU - Shen, Mylène

AU - Tastet, Lionel

AU - Ng, Arnold C.T.

AU - Abou, Rachid

AU - Marsan, Nina Ajmone

AU - Mertens, Bart

AU - Dulgheru, Raluca

AU - Lancellotti, Patrizio

AU - Clavel, Marie Annick

AU - Pibarot, Philippe

AU - Genereux, Philippe

AU - Leon, Martin B.

AU - Delgado, Victoria

AU - Bax, Jeroen J.

PY - 2018/9

Y1 - 2018/9

N2 - IMPORTANCE The optimal timing to operate in patients with asymptomatic severe aortic stenosis (AS) remains controversial. Left ventricular global longitudinal strain (LV GLS) may help to identify patients who might benefit from undergoing earlier aortic valve replacement. OBJECTIVE To investigate the prevalence of impaired LV GLS, the natural course of LV GLS, and its prognostic implications in patients with asymptomatic severe AS with preserved left ventricular ejection fraction (LVEF). DESIGN, SETTING, AND PARTICIPANTS This registry-based study included the institutional registries of 3 large tertiary referral centers and 220 patients with asymptomatic severe AS and preserved LVEF (>50%) who were matched for age and sex with 220 controls without structural heart disease. The echocardiograms of patients and controls were performed between 1998 and 2017. EXPOSURES Both clinical and echocardiographic data were assessed retrospectively. Severe AS was defined by an indexed aortic valve area less than 0.6 cm2/m2. Left ventricular global longitudinal strain was evaluated on transthoracic echocardiography using speckle tracking imaging. MAIN OUTCOMES AND MEASURES The prevalence of impaired LV GLS, the natural course of LV GLS, and the association of impaired LV GLS with symptom onset and the need for aortic valve intervention. RESULTS Two hundred twenty patients (mean [SD] age, 68 [13] years; 126 men [57%]) were included. Despite comparable LVEF, LV GLS was significantly impaired in patients with asymptomatic severe AS compared with age- and sex-matched controls without AS (mean [SD] LV GLS, -17.9% [2.5%] vs -19.6%[2.1%]; P < .001). After a median follow-up of 12 (interquartile range, 7-23) months, mean (SD) LV GLS significantly deteriorated (-18.0% [2.6%] to -16.3%[2.8%]; P < .001) while LVEF remained unchanged. Patients with impaired LV GLS at baseline (>-18.2%) showed a higher risk for developing symptoms (P = .02) and needing aortic valve intervention (P = .03) at follow-up compared with patients with more preserved LV GLS (≤-18.2%). CONCLUSIONS AND RELEVANCE Subclinicalmyocardial dysfunction that is characterized by impaired LV GLS is often present in patients with asymptomatic severe AS with preserved LVEF. Left ventricular global longitudinal strain further deteriorates over time and impaired LV GLS at baseline is associated with an increased risk for progression to the symptomatic stage and the need for aortic valve intervention.

AB - IMPORTANCE The optimal timing to operate in patients with asymptomatic severe aortic stenosis (AS) remains controversial. Left ventricular global longitudinal strain (LV GLS) may help to identify patients who might benefit from undergoing earlier aortic valve replacement. OBJECTIVE To investigate the prevalence of impaired LV GLS, the natural course of LV GLS, and its prognostic implications in patients with asymptomatic severe AS with preserved left ventricular ejection fraction (LVEF). DESIGN, SETTING, AND PARTICIPANTS This registry-based study included the institutional registries of 3 large tertiary referral centers and 220 patients with asymptomatic severe AS and preserved LVEF (>50%) who were matched for age and sex with 220 controls without structural heart disease. The echocardiograms of patients and controls were performed between 1998 and 2017. EXPOSURES Both clinical and echocardiographic data were assessed retrospectively. Severe AS was defined by an indexed aortic valve area less than 0.6 cm2/m2. Left ventricular global longitudinal strain was evaluated on transthoracic echocardiography using speckle tracking imaging. MAIN OUTCOMES AND MEASURES The prevalence of impaired LV GLS, the natural course of LV GLS, and the association of impaired LV GLS with symptom onset and the need for aortic valve intervention. RESULTS Two hundred twenty patients (mean [SD] age, 68 [13] years; 126 men [57%]) were included. Despite comparable LVEF, LV GLS was significantly impaired in patients with asymptomatic severe AS compared with age- and sex-matched controls without AS (mean [SD] LV GLS, -17.9% [2.5%] vs -19.6%[2.1%]; P < .001). After a median follow-up of 12 (interquartile range, 7-23) months, mean (SD) LV GLS significantly deteriorated (-18.0% [2.6%] to -16.3%[2.8%]; P < .001) while LVEF remained unchanged. Patients with impaired LV GLS at baseline (>-18.2%) showed a higher risk for developing symptoms (P = .02) and needing aortic valve intervention (P = .03) at follow-up compared with patients with more preserved LV GLS (≤-18.2%). CONCLUSIONS AND RELEVANCE Subclinicalmyocardial dysfunction that is characterized by impaired LV GLS is often present in patients with asymptomatic severe AS with preserved LVEF. Left ventricular global longitudinal strain further deteriorates over time and impaired LV GLS at baseline is associated with an increased risk for progression to the symptomatic stage and the need for aortic valve intervention.

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