Clinical InvestigationValvular Heart DiseaseRelationship between Longitudinal Strain and Symptomatic Status in Aortic Stenosis
Section snippets
Study Population
We prospectively enrolled patients with AS at two institutions (Bichat Hospital, Paris, France, and Henri-Mondor Hospital, Creteil, France) from February 2009 to June 2010. The inclusion criterion was pure, at least mild AS (defined by a mean pressure gradient [MPG] > 10 mm Hg). Exclusion criteria were more than mild coexisting aortic regurgitation (defined by a vena contracta width ≥ 3 mm or a regurgitant volume ≥ 30 mL)9 or other valvular heart disease, segmental LV wall motion abnormality
Population Characteristics
We prospectively enrolled 171 patients (mean age, 73 ± 12 years; 40% women) with at least mild AS from two centers (127 from Bichat Hospital and 44 from Henri-Mondor Hospital). Hypertension was present in 65% of patients, and 17% had known histories of CAD. The mean LVEF was 62 ± 9% (median, 65%; range, 25%–79%), and most patients had preserved LVEFs (≥50% in 89% of patients). The mean AVA was 0.99 ± 0.43 cm2 (median, 0.93 cm2; range, 0.30–2.00 cm2), the mean MPG was 44 ± 23 mm Hg (median, 42
Discussion
In the present study, in a two-center cohort of patients with wide ranges of symptoms, LVEFs, and AS severity, we showed that BLS but not GLS was independently associated with symptomatic status. However, there was an important overlap among groups, and absolute differences of either GLS or BLS between symptomatic and asymptomatic patients with severe AS and preserved LVEFs were close to measurements' reproducibility. Thus, our results raise caution regarding the sole use of longitudinal
Conclusions
In this prospective two-center cohort of patients with wide ranges of AS severity, symptoms, and ejection fractions, we showed that BLS but not GLS was independently associated with symptomatic status. However, differences between groups were small, close to measurements' reproducibility, with an important overlap among subgroups, raising caution regarding the use of longitudinal strain, at least as a single criterion, in the decision-making process of patients with severe asymptomatic AS.
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2024, Journal of the American Society of EchocardiographyStrain Imaging: An Everyday Tool for the Perioperative Echocardiographer
2020, Journal of Cardiothoracic and Vascular AnesthesiaThe Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis
2019, Journal of the American Society of EchocardiographyCitation Excerpt :In this study, the difference between GLS and BLS was significantly lower compared with the study by Lafitte et al.17 The reasons for the changes in the values in GLS and BLS between the studies may be related to differences in the studied population, including AS severity and the presence of coronary disease. This may also be related to image quality and to software version.35,36 There are no reports on the significance of peak exercise BLS in asymptomatic patients with AS.
Echocardiographic Imaging for Transcatheter Aortic Valve Replacement
2018, Journal of the American Society of EchocardiographyPrognostic Value of Left Ventricular Deformation Parameters in Patients with Severe Aortic Stenosis: A Pilot Study of the Usefulness of Strain Echocardiography
2017, Journal of the American Society of EchocardiographyCitation Excerpt :On the basis of our studies of healthy control subjects and different cardiomyopathies, mechanical dispersion > 65 to 70 msec seems to be an equitable cutoff value in patients with severe AS, in whom fibrosis, ischemia, and ventricular arrhythmias might promote adverse outcomes. The presence of abnormal LV mechanics in patients with AS and preserved LVEFs is well known.26-29 Previous studies have shown that these patients have reduced longitudinal myocardial function that improves after AVR.30
The Aortic Stenosis in Elderly: Determinant of Progression (COFRASA) and Genetic of Aortic Valve Stenosis: Clinical and Therapeutic Implications (GENERAC) studies are supported grants from Assistance Publique – Hôpitaux de Paris (PHRC National 2005 and PHRC Regional 2007) (ClinicalTrials.gov NCT00338676 and NCT00647088).