Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic Stenosis
Background. Left ventricle (LV) global longitudinal strain (GLS) at rest has shown prognostic value in patients (pts) with severe aortic stenosis (SAS). Contractile reserve (CR) during exercise stress echo (ESE) estimated via GLS (CR-GLS) could better stratify the asymptomatic patients who could ben...
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| Format: | Article |
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MDPI AG
2022-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/3/689 |
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| author | Rosina Arbucci Diego M. Lowenstein Haber María Graciela Rousse Ariel K. Saad Liliana Martínez Golleti Natalio Gastaldello Miguel Amor Cristian Caniggia Pablo Merlo Gustavo Zambrana Marcela Galello Esteban Clos Vicente Mora Jorge A. Lowenstein |
| author_facet | Rosina Arbucci Diego M. Lowenstein Haber María Graciela Rousse Ariel K. Saad Liliana Martínez Golleti Natalio Gastaldello Miguel Amor Cristian Caniggia Pablo Merlo Gustavo Zambrana Marcela Galello Esteban Clos Vicente Mora Jorge A. Lowenstein |
| author_sort | Rosina Arbucci |
| collection | DOAJ |
| description | Background. Left ventricle (LV) global longitudinal strain (GLS) at rest has shown prognostic value in patients (pts) with severe aortic stenosis (SAS). Contractile reserve (CR) during exercise stress echo (ESE) estimated via GLS (CR-GLS) could better stratify the asymptomatic patients who could benefit from early intervention. Aims. To determine the long-term prognostic value of CR-GLS in patients with asymptomatic SAS with an ESE without inducible ischemia. Additionally, to compare the prognostic value of CR assessed via ejection fraction (CR-EF) and CR-GLS. Methods. In a prospective, single-center, observational study between 2013 and 2019, 101 pts with asymptomatic SAS and preserved left ventricular ejection fraction (LVEF) > 55% were enrolled. CR was considered present with an exercise-rest increase in LVEF (Simpson’s rule) ≥ 5 points and > 2 absolute points in GLS. Patients were assigned to 2 groups (G): G1: 56 patients with CR-GLS present; and G2: 45 patients CR-GLS absent. All patients were followed up. Results. G2 Patients were older, with lower exercise capability, less aortic valve area (AVA), a higher peak aortic gradient, and less LVEF (71.5% ± 5.9 vs. 66.8% ± 7.9; <i>p</i> = 0.002) and GLS (%) at exercise (G1: −22.2 ± 2.8 vs. G2: −18.45 ± 2.4; <i>p</i> = 0.001). During mean follow-up of 46.6 ± 3.4 months, events occurred in 45 pts., with higher incidence in G2 (G2 = 57.8% vs. G1 = 42.2%, <i>p</i> < 0.01). At Cox regression analysis, CR-GLS was an independent predictor of major cardiovascular events (HR: 1.98, 95% CI 1.09–3.58, <i>p</i> = 0.025). Event-free survival was lower for patients with CR-GLS absent (log rank test <i>p</i> = 0.022). CR-EF was not outcome predictive (log rank test <i>p</i> 0.095). Conclusions: In patients with asymptomatic SAS, the absence of CR-GLS during ESE is associated with worse prognosis. Additionally, CR-GLS was a better predictor of events than CR-EF. |
| first_indexed | 2024-03-09T23:41:07Z |
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| id | doaj.art-a12d1531467d4e048c87833adb15efa9 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
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| last_indexed | 2024-03-09T23:41:07Z |
| publishDate | 2022-01-01 |
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| spelling | doaj.art-a12d1531467d4e048c87833adb15efa92023-11-23T16:52:29ZengMDPI AGJournal of Clinical Medicine2077-03832022-01-0111368910.3390/jcm11030689Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic StenosisRosina Arbucci0Diego M. Lowenstein Haber1María Graciela Rousse2Ariel K. Saad3Liliana Martínez Golleti4Natalio Gastaldello5Miguel Amor6Cristian Caniggia7Pablo Merlo8Gustavo Zambrana9Marcela Galello10Esteban Clos11Vicente Mora12Jorge A. Lowenstein13Cardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaDepartment of Cardiology, Hospital Universitario Dr. Peset, 46017 Valencia, SpainCardiodiagnosis Department, Investigaciones Médicas, Viamonte 1871, CABA, Buenos Aires 1056, ArgentinaBackground. Left ventricle (LV) global longitudinal strain (GLS) at rest has shown prognostic value in patients (pts) with severe aortic stenosis (SAS). Contractile reserve (CR) during exercise stress echo (ESE) estimated via GLS (CR-GLS) could better stratify the asymptomatic patients who could benefit from early intervention. Aims. To determine the long-term prognostic value of CR-GLS in patients with asymptomatic SAS with an ESE without inducible ischemia. Additionally, to compare the prognostic value of CR assessed via ejection fraction (CR-EF) and CR-GLS. Methods. In a prospective, single-center, observational study between 2013 and 2019, 101 pts with asymptomatic SAS and preserved left ventricular ejection fraction (LVEF) > 55% were enrolled. CR was considered present with an exercise-rest increase in LVEF (Simpson’s rule) ≥ 5 points and > 2 absolute points in GLS. Patients were assigned to 2 groups (G): G1: 56 patients with CR-GLS present; and G2: 45 patients CR-GLS absent. All patients were followed up. Results. G2 Patients were older, with lower exercise capability, less aortic valve area (AVA), a higher peak aortic gradient, and less LVEF (71.5% ± 5.9 vs. 66.8% ± 7.9; <i>p</i> = 0.002) and GLS (%) at exercise (G1: −22.2 ± 2.8 vs. G2: −18.45 ± 2.4; <i>p</i> = 0.001). During mean follow-up of 46.6 ± 3.4 months, events occurred in 45 pts., with higher incidence in G2 (G2 = 57.8% vs. G1 = 42.2%, <i>p</i> < 0.01). At Cox regression analysis, CR-GLS was an independent predictor of major cardiovascular events (HR: 1.98, 95% CI 1.09–3.58, <i>p</i> = 0.025). Event-free survival was lower for patients with CR-GLS absent (log rank test <i>p</i> = 0.022). CR-EF was not outcome predictive (log rank test <i>p</i> 0.095). Conclusions: In patients with asymptomatic SAS, the absence of CR-GLS during ESE is associated with worse prognosis. Additionally, CR-GLS was a better predictor of events than CR-EF.https://www.mdpi.com/2077-0383/11/3/689aortic stenosisexercise echocardiographystrain rate imagingaortic valve replacement |
| spellingShingle | Rosina Arbucci Diego M. Lowenstein Haber María Graciela Rousse Ariel K. Saad Liliana Martínez Golleti Natalio Gastaldello Miguel Amor Cristian Caniggia Pablo Merlo Gustavo Zambrana Marcela Galello Esteban Clos Vicente Mora Jorge A. Lowenstein Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic Stenosis Journal of Clinical Medicine aortic stenosis exercise echocardiography strain rate imaging aortic valve replacement |
| title | Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic Stenosis |
| title_full | Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic Stenosis |
| title_fullStr | Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic Stenosis |
| title_full_unstemmed | Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic Stenosis |
| title_short | Long Term Prognostic Value of Contractile Reserve Assessed by Global Longitudinal Strain in Patients with Asymptomatic Severe Aortic Stenosis |
| title_sort | long term prognostic value of contractile reserve assessed by global longitudinal strain in patients with asymptomatic severe aortic stenosis |
| topic | aortic stenosis exercise echocardiography strain rate imaging aortic valve replacement |
| url | https://www.mdpi.com/2077-0383/11/3/689 |
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