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Cited by 183Cardiac Valve Diseases and TreatmentsCardiovascular Function and Risk FactorsCardiac Imaging and Diagnostics

Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Aortic Stenosis and Preserved Ejection Fraction

Kusunose, Kenya, Goodman, Andrew, Parikh, Roosha, Barr, Tyler, Agarwal, Shikhar, Popovic, Zoran B., Grimm, Richard A., Griffin, Brian P. +1 more·2014·Circulation: Cardiovascular Imaging
DOI 10.1161/circimaging.114.002041
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Abstract

Background—: We sought to assess the utility of left ventricular global longitudinal strain (LV-GLS) in predicting mortality in moderate to severe and paradoxical severe aortic stenosis (AS) patients with preserved ejection fraction. Methods and Results—: We studied 395 AS patients (70±14 years, 57% men) with aortic valve area <1.3 cm 2 evaluated between January to June 2008 (excluding severe other valve disease and LV ejection fraction <50%). Clinical and echocardiographic data were recorded. LV-GLS was analyzed using Velocity Vector Imaging. AS patients were classified as (a) moderate–severe (n=93; aortic valve area, 1.1–1.3 cm 2 ), (b) standard severe (n=161; aortic valve area, ≤1 cm2; mean gradient ≥40 mm Hg), and (c) paradoxical severe (n=141; aortic valve area, ≤1 cm2 and mean gradient <40 mm Hg). Additive Euroscore was 7±3. The association of LV-GLS with all-cause mortality was assessed after risk-adjustment using Cox proportional hazards models. Median LV-GLS was −14.8% (interquartile range, −17.2%, −12.1%). At 4.4±1.4 years, there were 92 (23%) deaths. On multivariable Cox analysis, additive Euroscore (hazard ratio, 1.19; 1.13–1.27; P <0.001), New York Heart Association class (hazard ratio, 1.44; 1.11–1.87; P <0.001), AV surgery with time-dependent covariate analysis (hazard ratio, 0.29; 0.19–0.45; P <0.001), and LV-GLS (hazard ratio, 1.05; 1.03–1.07; P <0.001) were independent predictors of mortality. LV-GLS <−12.1% (4th quartile) was associated with significantly reduced survival. Addition of LV-GLS to clinical parameters (additive Euroscore+New York Heart Association class) led to significant improvement in prediction of mortality (χ 2 increased from 48 to 58; P <0.01). Conclusions—: LV-GLS independently predicts mortality in moderate–severe and severe AS patients with preserved LV ejection fraction, providing incremental prognostic utility, in addition to standard clinical and echocardiographic parameters.

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  • In pressure overload cardiomyopathies, there is early selective alteration of myocardial fiber shortening in the subendocardial layer, where ischaemia and fibrosis are generally more pronounced.

    “In pressure overload cardiomyopathies, there is an early and selective alteration of the shortening of myocardial fibers within the subendocardial layer where ischaemia and fibrosis are generally more pronounced (Figure 5)128–130.”

    From Calcific aortic stenosis (2016) · cites this paper as [130]

    The Discussion (page not provided) says that longitudinal strain can reveal subtle myocardial abnormalities in aortic stenosis before conventional measures do, and reports an association between strain and fibrosis. It does not establish selective early impairment of subendocardial fiber shortening or say that ischemia and fibrosis are more pronounced in that layer; its evidence is also specific to aortic stenosis rather than pressure-overload cardiomyopathies generally. (LLM, conf=0.83)

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Authors
Kusunose, K., Goodman, A., Parikh, R., Barr, T., Agarwal, S., Popovic, Z. B., Grimm, R. A., Griffin, B. P., & Desai, M. Y.
Affiliations
  • Cleveland Clinic (US)
  • From the Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
Corresponding author
  • Kusunose, Kenya
  • Goodman, Andrew
ORCID
Venue
Circulation: Cardiovascular Imaging
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2014-11
Volume
7
Issue
6
Pages
938-945
ISSN
  • 1941-9651 (ISSN-L)
  • 1942-0080
DOI
10.1161/circimaging.114.002041
OpenAlex
W2548762833
Cited by
183
References
34
Citations by year
2026: 5 · 2025: 7 · 2024: 8 · 2023: 9 · 2022: 13 · 2021: 10 · 2020: 29 · 2019: 28 · 2018: 23 · 2017: 25 · 2016: 15 · 2015: 11
FWCI
11.66
Type
journal article
Language
en
Open access
closed
Locations
  • Circulation Cardiovascular Imaging (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords
aortic stenosis, preserved ejection fraction, left ventricular global longitudinal strain, mortality prediction, prognosis, velocity vector imaging, aortic valve replacement, risk stratification, NYHA functional class, aortic valve area, aortic valve gradient, cardiac magnetic resonance imaging, echocardiography, left ventricular function
MeSH terms
Aged, Aged, 80 and over, Aortic Valve Stenosis, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Retrospective Studies, Risk Factors, Severity of Illness Index, Stroke Volume, Time Factors, Multivariate Analysis, Chi-Square Distribution, Linear Models, Proportional Hazards Models, Ventricular Function, Left, Nonlinear Dynamics, Risk Assessment, Echocardiography, Doppler, Pulsed

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