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

Cintia Soledad Laurenzano, María Florencia Cerda Jorgi, Daniel Agustín Chirino Navarta, Hugo Mosto, Alejandra Díaz Casale

Abstract


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

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