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


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


Ferreira-González, Pinar-Sopena J, Ribera A, Marsal JR, Cascant P, González-Alujas T, et al. Prevalence of calcific aortic valve disease in the elderly and associated risk factors: a population-based study in a Mediterranean area. Eur J Prev Cardiol 2013:20:1022–30.

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA et al. 2017 AHA / ACC Focused Update of the 2014 AHA/ ACC Guideline for the Management of Patients With Valvular Heart Disease. A Report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017;135:1159-95.

Helmut DT. Guía ESC / EACTS 2017 sobre el tratamiento de las valvulopatías Grupo de Trabajo de la Sociedad Europea de Cardiología (ESC) y la European Association for CardioThoracic Surgery (EACTS) sobre el tratamiento de las valvulopatías. Rev Esp Cardiol 2018;71:110.e1-e47.

Lax J, Stutzbach P, Beck M, Perea F, Cianciulli T, Grancelli H. et al. Sociedad Argentina de Cardiología . Área de Consensos y Normatizaciones. Consenso de valvulopatías. Rev Argent Cardiol 2015;83(supl 2):1-104.

Dahl JS, Barros-Gomes S, Videbæk L, Poulsen MK, Issa IF, Carter-Storch R, et al. Early Diastolic Strain Rate in Relation to Systolic and Diastolic Function and Prognosis in Aortic Stenosis. JACC Cardiovasc Imaging 2016;9:519-28.

Migliore R, Chianelli O, Adaniya M, Miramont G, Gonzalez G, Barranco MA, et al. Evaluación de la función sistólica en la estenosis aórtica mediante la fracción de acortamiento mesoparietal. Su relación con la hipertrofia. Rev Argent Cardiol 2004;72:439–44.

Lafitte S, Perlant M, Reant P, Serri K, Douard H, DeMaria A, et al. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr 2009;10:414–9.

Donal E, Bergerot C, Thibault H, Ernande L, Loufoua J, Augeul L,et al. Influence of afterload on left ventricular radial and longitudinal systolic functions: a two-dimensional strain imaging study. Circulation 1994;89:122–31.

Hita A, Baratta S, Chejtman D, Benticuaga A, Constantini R et al.Relación entre el strain rate y la estructura miocárdica en la estenosis aórtica grave. Rev Argent Cardiol 2015;83:35-42.

Vega S, Córdova L, Gabrielli P, Mcnab P, Saavedra R. Hipertrofia ventricular izquierda con patrón de strain característico. Rev Chil Cardiol 2017;36:249-53.

Wang B, Chen H, Shu X, Hong T, Lai H, Wang C, et al. Emerging role of echocardiographic strain/strain rate imaging and twist in systolic function evaluation and operative procedure in patients with aortic stenosis. Interact Cardiovasc Thorac Surg 2013;17:384-91.

Delgado V, Bertini M, Antoni ML, Van Bommel RJ, Van Rijnsoever EP. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: a two-dimensional speckle tracking analysis. Eur Heart J 2011;12:1542–50.

Lafitte S, Perlant M, Reant P, Serri K, Douard H, DeMaria A, Roudaut R. Impact of impaired myocardial deformations on exercise tolerance and prognosis in patients with asymptomatic aortic stenosis. Eur J Echocardiogr 2009;10:414-9.

Kearney LG, Lu K, Ord M, Patel SK, Profitis K, Matalanis G, et al. Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging 2012;13:827-33.

Lancellotti P, Donal E, Magne J, Moonen M, O’Connor K, Daubert JC, et al. Risk stratification in asymptomatic moderate to severe aortic stenosis : the importance of the valve, arterial and ventricular interplay. Heart 2010;96:1364-71.

Fries B, Liu D, Gaudron P, Hu K, Nordbeck P, Ertl G, et al. Role of Global Longitudinal Strain in the Prediction of Outcome in Patients With Severe Aortic Valve Stenosis. Am J Cardiol 2017;120:640–7.

Nagata Y, Takeuchi M, Wu VC, Izumo M, Suzuki K, Sato K, et al. Prognostic value of LV deformation parameters using 2D and 3D speckle-tracking echocardiography in asymptomatic patients with severe aortic stenosis and preserved LV ejection fraction. JACC Cardiovasc Imaging 2015;8:235–45.

Carstensen HG, Larsen LH, Hassager C, Kofoed KF, Jensen JS, Mogelvang R. Basal longitudinal strain predicts future aortic valve replacement in asymptomatic patients with aortic stenosis. Eur HeartJ Cardiovasc Imaging 2016;17:283-92.

Pirat B, Khoury DS, Hartley CJ, Tiller L, Rao L, Schulz DG, et al. A novel feature-tracking echocardiographic method for the quantitation of regional myocardial function: validation in an animal model of ischemia-reperfusion. J Am Coll Cardiol 2008;51:651–9.

Chen J, Cao T, Duan Y, Yuan L. Velocity vector imaging in assessing the regional systolic function of patients with post myocardial infarction. Echocardiography 2007;24:940-5.

Kim DH, Kim HK, Kim MK, Chang SA, Kim YJ, Kim MA, et al. Velocity Vector Imaging in the Measurement of Left Ventricular TwistMechanics : Head-to-Head One Way Comparison Between SpeckleTracking Echocardiography and Velocity Vector Imaging. J Am Soc Echocardiogr 2009;22:1344–52.

Vannan MA, Pedrizzetti G, Li P, Gurudevan S, Houle H, Jackson J. Effect of cardiac resynchronization therapy on longitudinal and circumferential left ventricular mechanics by velocity vector imaging: description and initial clinical application of a novel method using high-frame rate B-mode echocardiographic images-. Echocardiography 2005;22:826–30.

Cannesson M, Tanabe M, Suffoletto MS, Schwartzman D, Lii JG. Velocity Vector Imaging to Quantify Ventricular Dyssynchrony and Predict Response to Cardiac Resynchronization Therapy. Am J Cardiol 2006;98:949-53.

Gerber IL, Stewart RA, Legget ME, West TM, French RL, Sutton TM, et al. Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis. Circulation 2003;107:1884–90.

Weber M, Arnold R, Rau M, Brandt R, Berkovitsch A, Mitrovic V, et al. Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve disease. Eur Heart J 2005;26:1023–30.

Gerber IL, Legget ME, West TM, Richards AM, Stewart RA. Usefulness of serial measurement of N-terminal pro-brain natriuretic peptide plasma levels in asymptomatic patients with aortic stenosis to predict symptomatic deterioration. Am J Cardiol 2005;26:898–901.

Cimadevilla C, Cueff C, Hekimian G, Dehoux M, Lepage L, Iung B, et al. Prognostic value of B-type natriuretic peptide in elderly patientswith aortic valve stenosis : the COFRASA – GENERAC study. Heart 2013;99:461-7.

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