Left ventricular global longitudinal strain influences natural history in aortic stenosis

Introduction: Several previous studies showed that 2-dimensional global longitudinal strain (GLS) was a significant predictor for survival in aortic stenosis (AS) patients, especially surgically treated patients.
Objective: To assess the impact of GLS on natural his-tory in moderate and severe AS patients.
Methods: All 342 retrospectively included patients were diagnosed with moderate or severe AS and pre-served left ventricular ejection fraction. Patient history, clinical data, biology results and 2D echocardiographic parameters including GLS were recorded. Patients were divided into 4 groups: moderate AS (MAS, n=122), pa-radoxical normal flow low gradient AS (PLG, n=64), paradoxical low flow low gradient AS (LFLG, n=74) and severe AS (SAS, n=82). Primary end point was all-cause mortality. To evaluate natural history, patients undergoing aortic valve replacement were censored at the time of surgery (n=66).
Results: Average GLS was -18.20±3.39 overall, -18,53±3,16 for MAS, -19,05±2,95 for PLG, -17,07±3,42 for LFLG and -18,09±3,62 for SAS, with the difference between groups being statistically significant (p=0.002). During a mean follow-up of 38 months, 164 (47.9%) died. COX univariate analysis identified age, BMI, atri-al fibrillation, hemoglobin level, glomerular filtration rate, transaortic mean gradient, aortic valve area index and GLS (p<0.001, HR: 1.089 [1.039, 1.142]) to be pre-dictors for the primary end-point. Moreover, stratifying the COX analysis by the 4 AS groups indicated GLS to be a significant predictor of death (p=0.003). Further-more, GLS improved the COX multivariate model that already included the other variables proven significant in univariate analysis (X2 from 68.65 to 73.93).
Conclusions: Our study indicates, that GLS has a sig-nificant, independent, influence on natural history in patients with at least moderate AS, independently to other predictive factors. This data prompts a closer look into the role of GLS in future clinical practice in patients with AS.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)