Incremental Value of Biventricular Strain in Patients with Severe Aortic Stenosis

• Published in: Journal of cardiovascular development and disease Vol. 11; no. 3; p. 90
• Main Authors: Sarrazyn, Camille, Galloo, Xavier, Meucci, Maria Chiara, Butcher, Steele C, Hirsawa, Kensuke, Myagmardorj, Rinchyenkhand, van der Kley, Frank, De Backer, Tine, Bax, Jeroen J, Ajmone Marsan, Nina
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.03.2024; MDPI
• Subjects: Aortic valve stenosis; Belgium; Care and treatment; Doppler effect; echocardiography; Health aspects; imaging; left ventricular global longitudinal strain; Medical prognosis; Mortality; Patients; Pulmonary arteries; Regression analysis; right ventricular free wall strain; Software; speckle-tracking echocardiography; Statistical analysis; Survival analysis; valvular heart disease; Belgium; Norway; transcatheter aortic valve implantation; right ventricular free wall strain; echocardiography; left ventricular global longitudinal strain; aortic valve stenosis; valvular heart disease; speckle-tracking echocardiography; imaging
• DOI: 10.3390/jcdd11030090
• ISSN: 2308-3425

(1) Background: Left ventricular global longitudinal (LVGLS) and right ventricular free wall strain (RVFWS) demonstrated separate prognostic values in patients with severe aortic stenosis (AS). However, studies evaluating the combined assessment of LVGLS and RVFWS have shown contradictory results. This study explored the prognostic value of combining LVGLS and RVFWS in a large group of severe AS patients referred for transcatheter aortic valve implantation. (2) Methods: Patients were classified into three groups: preserved (LVGLS ≥ 15% AND RVFWS > 20%), single-ventricle impaired (LVGLS < 15% OR RVFWS ≤ 20%), or biventricular-impaired strain group (LVGLS < 15% AND RVFWS ≤ 20%). The cut-off values were based on previously published data and spline analyses. The endpoint was all-cause mortality. (3) Results: Of the 712 patients included (age 80 ± 7 years, 53% men), 248 (35%) died. The single-ventricle impaired and biventricular-impaired (vs. preserved) strain groups showed significantly lower 5-year survival rates (68% and 55% vs. 77%, respectively, < 0.001). Through multivariable analysis, single-ventricle impaired (HR 1.762; 95% CI: 1.114-2.788; = 0.015) and biventricular-impaired strain groups (HR 1.920; 95% CI: 1.134-3.250; = 0.015) were independently associated with all-cause mortality. These findings were confirmed with a sensitivity analysis in patients with preserved LV ejection fraction. (4) Conclusions: In patients with severe AS, biventricular strain allows better risk stratification, even if LV ejection fraction is preserved.