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

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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., Desai, Milind Y.·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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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: Kusunose, Kenya
Parikh, Roosha
Agarwal, Shikhar
Grimm, Richard A.
Griffin, Brian P.
Desai, Milind Y.
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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Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Aortic Stenosis and Preserved Ejection Fraction

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