Relationship between Longitudinal Strain and Symptomatic Status in Aortic Stenosis

• Published in: Journal of the American Society of Echocardiography Vol. 26; no. 8; pp. 868 - 874
• Main Authors: Attias, David, MD, Macron, Laurent, MD, Dreyfus, Julien, MD, Monin, Jean-Luc, MD, PhD, Brochet, Eric, MD, Lepage, Laurent, MD, Hekimian, Guillaume, MD, Iung, Bernard, MD, Vahanian, Alec, MD, Messika-Zeitoun, David, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.08.2013
• Subjects: Aged; Aortic stenosis; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnostic imaging; Cardiovascular; Cohort Studies; Echocardiography; Echocardiography - methods; Elasticity Imaging Techniques - methods; Female; France - epidemiology; Humans; Image Interpretation, Computer-Assisted - methods; Longitudinal strain; Male; Reproducibility of Results; Sensitivity and Specificity; Speckle-tracking; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Aortic stenosis; Longitudinal strain; MPG; COFRASA; Left ventricular; ALS; BLS; LVEF; Apical longitudinal strain; Global longitudinal strain; LV; AUC; GLS; Left ventricular ejection fraction; Genetic of Aortic Valve Stenosis: Clinical and Therapeutic Implications; Aortic valve area; Mean pressure gradient; Echocardiography; CAD; AVA; Coronary artery disease; AS; Area under the receiver operating characteristic curve; Basal longitudinal strain; Aortic Stenosis in Elderly: Determinant of Progression; Speckle-tracking; GENERAC
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2013.05.004

Background Global longitudinal strain (GLS) and basal longitudinal strain (BLS) assessed using two-dimensional speckle-tracking imaging have been proposed as subtle markers of left ventricular (LV) systolic dysfunction with potential prognostic value in patients with aortic stenosis (AS). The aim of this study was to evaluate the relationship between longitudinal strain and symptomatic status in patients with AS. Methods GLS and BLS were measured in 171 patients with pure, isolated, at least mild AS prospectively enrolled at two institutions. The population was divided into four groups: asymptomatic nonsevere AS ( n  = 55), asymptomatic severe AS with preserved LV ejection fraction (LVEF; ≥50%) ( n  = 37), symptomatic severe AS with preserved LVEF ( n  = 60), and severe AS with reduced LVEF (<50%) ( n  = 19). Results GLS was significantly different among the four groups ( P < .0001), but the difference was due mainly to patients with reduced LVEFs. In addition, there was an important overlap among the groups, and in multivariate analysis, after adjustment for age, gender, AS severity, and LVEF, GLS was not an independent predictor of symptomatic status ( P  = .07). BLS was also significantly different among the four groups ( P < .0001) but in contrast was independently associated with symptomatic status ( P < .0001). However, as for GLS, there was an important overlap between groups and differences were close to intraobserver or interobserver variability (1.3 ± 1.1% and 2.0 ± 1.6%, respectively). Conclusions In this prospective multicenter cohort of patients with wide ranges of AS severity, symptoms, and LVEFs, BLS but not GLS was independently associated with symptomatic status. However, there was an important overlap among groups, and differences were close to measurements' reproducibility, raising caution regarding the use of longitudinal strain, at least as a single criterion, in the decision-making process for patients with severe asymptomatic AS.