Incremental Prognostic Value of Left Ventricular and Left Atrial Strain in Moderate Aortic Stenosis.

IF 6.7 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Imaging Pub Date : 2024-11-05 DOI:10.1093/ehjci/jeae285
Hyun-Jung Lee, Kyu Kim, Seo-Yeon Gwak, Iksung Cho, Geu-Ru Hong, Jong-Won Ha, Chi Young Shim
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Abstract

Aims: Patients with moderate aortic stenosis (AS) show a poor prognosis if they have high-risk features. We investigated the incremental prognostic value of left ventricular (LV) and left atrial (LA) strain in patients with moderate AS.

Methods and results: In a cohort of 923 patients with moderate AS (median age 74 years, men 55%, aortic valve area 1.18 [IQR 1.08-1.30] cm2, mean pressure gradient 25 [IQR 23-30] mmHg), LV global longitudinal strain (LV-GLS) and LA reservoir strain (LARS), were measured using speckle-tracking echocardiography. Absolute values of myocardial strain were used. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization.During a median of 5.9 years, the primary endpoint occurred in 186 patients (20.2%). The median LV-GLS and LARS were 17.7% (IQR 14.8-19.7) and 24.5% (IQR 18.7-29.3). LV-GLS (adjusted HR 0.92, 95% CI 0.87-0.97) and LARS (adjusted HR 0.97, 95% CI 0.95-0.99) were significant predictors of the primary outcome, independent of clinical and echocardiographic variables including LV ejection fraction. Notably, the prognostic value of LV-GLS was stronger than that of LARS, remaining significant after further adjustment for LARS. LV-GLS<17% and LARS<22% were identified as optimal cutoffs for the primary outcome. Patients with both reduced LV-GLS and LARS had the worst outcome (log-rank p<0.001). LV-GLS<17% and LARS<22% had incremental prognostic value on top of other clinical and echocardiographic variables.

Conclusion: In moderate AS, reduced LV-GLS and LARS have incremental prognostic value, and can refine risk stratification to identify high-risk patients.

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中度主动脉瓣狭窄患者左心室和左心房应变的增量预后价值
目的:中度主动脉瓣狭窄(AS)患者如果具有高危特征,预后较差。我们研究了左心室(LV)和左心房(LA)应变对中度主动脉瓣狭窄患者预后的增量价值:在一组 923 名中度 AS 患者(中位年龄 74 岁,男性 55%,主动脉瓣面积 1.18 [IQR 1.08-1.30] cm2,平均压力梯度 25 [IQR 23-30] mmHg)中,使用斑点追踪超声心动图测量了 LV 整体纵向应变 (LV-GLS) 和 LA 储能应变 (LARS)。使用的是心肌应变的绝对值。在中位 5.9 年的时间里,186 名患者(20.2%)出现了主要终点。LV-GLS和LARS的中位数分别为17.7%(IQR 14.8-19.7)和24.5%(IQR 18.7-29.3)。LV-GLS(调整后HR为0.92,95% CI为0.87-0.97)和LARS(调整后HR为0.97,95% CI为0.95-0.99)是主要结局的重要预测指标,与包括左心室射血分数在内的临床和超声心动图变量无关。值得注意的是,LV-GLS 的预后价值强于 LARS,在进一步调整 LARS 后仍具有显著性。结论:在中度强直性脊柱炎患者中,LV-GLS和LARS的降低具有递增的预后价值,可以完善风险分层以识别高危患者。
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来源期刊
European Heart Journal - Cardiovascular Imaging
European Heart Journal - Cardiovascular Imaging CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
11.60
自引率
9.70%
发文量
708
审稿时长
4-8 weeks
期刊介绍: European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology. The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.
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