Global strain in severe aortic valve stenosis relation to clinical outcome after aortic valve replacement

Jordi S. Dahl, Lars Videbæk, Mikael K. Poulsen, Torsten R. Rudbæk, Patricia Pellikka, Jacob E. Maller

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background-Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement is unknown. Methods and Results-A total of 125 patients with severe aortic stenosis and ejection fraction >40% scheduled for aortic valve replacement were evaluated preoperatively and divided into 4 groups according to GLS quartiles. Patients were followed up for 4 years. The primary end points were major adverse cardiac events (MACEs) defined as cardiovascular mortality and cardiac hospitalization because of worsening of heart failure; the secondary end point was cardiovascular mortality. MACE and cardiac mortality were significantly increased in patients with lower GLS. Estimated 5-year MACE was increased: first quartile 19% (n=6) / second quartile 20% (n=6) / third quartile 35% (n=11) / fourth quartile 49% (n=15 P=0.04. Patients with increased age, left ventricular hypertrophy, and left atrial dilatation were at increased risk. In Cox regression analysis, after correcting for standard risk factors and ejection fraction, GLS was found to be significantly associated with cardiac morbidity and mortality. In a stepwise Cox model with forward selection, GLS was the sole independent predictor: hazard ratio=1.13 (95% confidence interval, 1.02-1.25), P=0.04. Comparing the overall log likelihood ?2 of the predictive power of the multivariable model containing GLS was statistically superior to models based on EuroScore, history with ischemic heart disease, and ejection fraction. Conclusions-In patients with symptomatic severe aortic stenosis undergoing aortic valve replacement, reduced GLS provides important prognostic information beyond standard risk factors. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00294775.

Original languageEnglish (US)
Pages (from-to)613-620
Number of pages8
JournalCirculation: Cardiovascular Imaging
Volume5
Issue number5
DOIs
StatePublished - 2012

Fingerprint

Aortic Valve Stenosis
Aortic Valve
Mortality
Left Ventricular Hypertrophy
Proportional Hazards Models
Myocardial Ischemia
Dilatation
Hospitalization
Heart Failure
History
Regression Analysis
Clinical Trials
Confidence Intervals
Morbidity

Keywords

  • Aortic valve stenosis
  • Global strain
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Global strain in severe aortic valve stenosis relation to clinical outcome after aortic valve replacement. / Dahl, Jordi S.; Videbæk, Lars; Poulsen, Mikael K.; Rudbæk, Torsten R.; Pellikka, Patricia; Maller, Jacob E.

In: Circulation: Cardiovascular Imaging, Vol. 5, No. 5, 2012, p. 613-620.

Research output: Contribution to journalArticle

Dahl, Jordi S. ; Videbæk, Lars ; Poulsen, Mikael K. ; Rudbæk, Torsten R. ; Pellikka, Patricia ; Maller, Jacob E. / Global strain in severe aortic valve stenosis relation to clinical outcome after aortic valve replacement. In: Circulation: Cardiovascular Imaging. 2012 ; Vol. 5, No. 5. pp. 613-620.
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