Prognostic Value of Longitudinal Strain Measured by Velocity Vector Imaging, in Asymptomatic Severe Aortic Stenosis with Preserved Ejection

Eliana Aversa, Lorena M. Delgado Elías, Raúl Chirife, Noemí Marotta de Aguilar, Lucas Lettieri, Benjamín D. Elencwajg, Néstor H. López Cabanillas, Juan C. Jurado Grisales


Background: Longitudinal systolic strain (LSS) abnormalitiess have been described in patients with preserved ejection fraction(EF). The prognostic value of LSS in asymptomatic severe aortic stenosis (AoS) is under discussion.Objetive: The aim of this study was to assess whether LSS assessment using velocity vector imaging (VVI) predicts theprogression and indication of aortic valve replacement (AVR) in asymptomatic patients with severe AoS and preserved EF.Methods: The study included patients with severe AoS and preserved EF who were considered asymptomatic and withoutinitial indication for AVR. They underwent two, three and four-chamber echocardiography that evaluated LSS of each segmentand global longitudinal strain (GLS) by VVI, as well as NT-proBNP assessment. The primary endpoint was need for AVR.Results: A total of 57 patients with mean age 69±8 years, 49% women, were included in the study. After two years of follow-up,13 patients (22.8%) required AVR. This group had lower GLS (-15.5±3.4 vs.-18.9±3.1, p=0.03) and two-chamber LSS (-12.8±5.5vs.-16.3±5.6, p=0.04). In univariate analysis, GLS, NT-proBNP and the E/e’ ratio were predictors of the endpoint, while inthe multivariate analysis, only GLS was an independent predictor of need for AVR (HR: 1.28 (95% CI 1.04-1.58), p=0.01).Conclusions: Global longitudinal strain measured by VVI was an independent predictor of need for AVR.


Elencwajg B, López Cabanillas N, Cardinali E, Trainini J. Resincronizaciónventricular: nueva técnica y dispositivo para el implanteendocavitario de un catéter en el ventrículo izquierdo. Rev Argent Cardiol 2010; 78:143-6.

Elencwajg B, López Cabanillas N, Luis Cardinali E, Barisani J L,Trainini J, Fischer A, et al. The Jurdham procedure: Endocardial left ventricular lead insertion via a femoral transseptal sheath for cardiac resynchronization therapy pectoral device implantation.Heart Rhythm 2012; 9:1798-804.

Porter TR, Shillcutt SK, Adams MS, Desjardins G, Glas KE, OlsonJJ, et al. Guidelines for the Use of Echocardiography as a Monitor for Therapeutic Intervention in Adults: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2015;28:40-56.

Weissler A, Harris W, Schoenfeld C. Systolic time intervals in heart failure in man Circulation 1968;37:149-59.

Reant P, Dijos M, Donal E, Mignot A, Ritter P, Bordachar P, et al. Systolic time intervals as simple echocardiographic parameters ofleft ventricular systolic performance: correlation with ejection fraction and longitudinal two-dimensional strain. Eur J Echocardiogr 2010;11,834-44.

Garrard CL, Weissler AM, Dodge HT. The Relationship of Alterations in Systolic Time Intervals to Ejection Fraction in Patients with Cardiac Disease. Circulation 1970;42:455-62.

Dodge HT, Sandler H, Ballew DW, Lord JD Jr. The use of biplane angiocardiography for the measurement of left ventricular volume in man. Am Heart J 1960;60:762-76.

Rector TS, Francis GS, Cohn JN. Patients’self-assessment of

their congestive heart failure. Part 1 Patient perceived dysfunction and its poor correlation with maximal exercise tests. Heart Fail 1987;1:192-6

Rector TS, Kubo SH, Cohn JN. Patients’self-assessment of their congestive heart failure. Part 2: Content, reliability and validity of a new measure, the Minnesota Living with Heart Failure questionnaire. Heart Fail 1987;1:198-209.

Rector TS. A conceptual model of the quality of life in relation to heart failure. J Card Fail 2005; 11:173-6.

Weissler A, HarrisW, Schoenfeld C. Systolic time intervals

in heart failure in man. Circulation 1968; 37:149-59. http://doi.


Chirife R, Ruiz A, Gayet E, Mazzetti H, Pellegrini A, Tentori C.The Systolic Index: A Noninvasive Approach for the Assessment of Cardiac Function: Implications for Patients with DDD and CRT Devices. Pacing Clin Electrophysiol 2013;36:1284-93.

Chirife R, Spodick DH. Densitography: Anew method for evaluation

of cardiac performance at rest and during exercise. Am Heart

J 1972; 83:493-503.

Chirife R, Foerster JM, Bing OHL. Left ventricular ejection time by densitometry in patients at rest and during exercise, atrial pacing and atrial fibrillation. Comparison with central aortic pressure measurements. Circulation 1974;50:1200-4.

Aversa E, Chirife R, Sztyglic E, Mazzetti H, Mascheroni O,

Tentori MC. What we program is not what we get: Importance of

measuring the P-wave sensing offset in DDD pacemakers. Europace 2011;13(suppl_3):NP, June

Chirife R, Ruiz GA: Cardiac malfunction detected by systolic time intervals during right ventricular pacing. Heart Rhythm 2016;13:S261.

Chirife R, Ortega D, Barja L. Pacing-Induced Inter-ventricular conduction time. Expected values and its effect on left heart atrioventricular interval. Pacing Clin Electrophysiol 1993;16:1150 (Abstr).

Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM 3rd, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities:a report of the American College of Cardiology Foundation/AmericanHeart Association Task Force on Practice Guidelines. Circulation.2012; 126:1784-800.

Stockburger M, Fateh-Moghadam S, Nitardy A, Celebi O, Krebs A,Habedank D, et al. Baseline Doppler parameters are useful predictorsof chronic left ventricular reduction in size by cardiac resynchronizationtherapy. Europace 2008;10:69-74.

Chung E, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, MerlinoJ, et al. Results of the predictors of response to CRT (PROSPECT) trial. Circulation 2008;117:2608-16.

Mancini GB, Costello D, Bhargava V, Lew W, LeWinter M, Karliner JS. The isovolumic index: a new non-invasive approach to the assessment of left ventricular function in man. Am J Cardiol 1982;50:1401-8.

Full Text


  • There are currently no refbacks.

Licencia Creative Commons
The documents published in this journal are under the licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.

Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020