Incremental value of left ventricular global longitudinal strain in a newly proposed staging classification based on cardiac damage in patients with severe aortic stenosis

Author:

Vollema E Mara1,Amanullah Mohammed R2,Prihadi Edgard A1,Ng Arnold C T3,van der Bijl Pieter1,Sin Yoong Kong4,Ajmone Marsan Nina1,Ding Zee Pin2,Généreux Philippe567,Leon Martin B58,Ewe See Hooi2,Delgado Victoria1,Bax Jeroen J1

Affiliation:

1. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

2. Department of Cardiology, National Heart Centre Singapore, Singapore

3. Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia

4. Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore

5. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA

6. Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA

7. Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada

8. New York-Presbyterian Hospital/Columbia University, Medical Center, New York, NY, USA

Abstract

Abstract Aims Cardiac damage in severe aortic stenosis (AS) can be classified according to a recently proposed staging classification. The present study investigated the incremental prognostic value of left ventricular (LV) global longitudinal strain (GLS) over stages of cardiac damage in patients with severe AS. Methods and results From an ongoing registry, a total of 616 severe symptomatic AS patients with available LV GLS by speckle tracking echocardiography were selected and retrospectively analysed. Patients were categorized according to cardiac damage on echocardiography: Stage 0 (no damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). LV GLS was divided by quintiles and assigned to the different stages. The endpoint was all-cause mortality. Over a median follow-up of 44 [24–89] months, 234 (38%) patients died. LV GLS was associated with all-cause mortality independent of stage of cardiac damage. After incorporation of LV GLS by quintiles into the staging classification, Stages 2–4 were independently associated with outcome. LV GLS showed incremental prognostic value over clinical characteristics and stages of cardiac damage. Conclusion In this large single-centre cohort of severe AS patients, incorporation of LV GLS by quintiles in a novel proposed staging classification resulted in refinement of risk stratification by identifying patients with more advanced cardiac damage. LV GLS was shown to provide incremental prognostic value over the originally proposed staging classification.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging,General Medicine

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