Impact of aortic stenosis on layer-specific longitudinal strain: relationship with symptoms and outcome

[en] AIMS: The present study sought to assess the impact of aortic stenosis (AS) on myocardial function as assessed by layer-specific longitudinal strain (LS) and its relationship with symptoms and outcome. METHODS AND RESULTS: We compared 211 patients (56% males, mean age 73 ± 12 years) with severe AS and left ventricular ejection fraction (LVEF) ≥50% (114 symptomatic, 97 asymptomatic) with 50 controls matched for age and sex. LS was assessed from endocardium, mid-myocardium, and epicardium by 2D speckle-tracking echocardiography. Despite similar LVEF, multilayer strain values were significantly lower in symptomatic patients, compared to asymptomatic and controls [global LS: 17.9 ± 3.4 vs. 19.1 ± 3.1 vs. 20.7 ± 2.1%; endocardial LS: 20.1 ± 4.9 vs. 21.7 ± 4.2 vs. 23.4 ± 2.5%; epicardial LS: 15.8 ± 3.1 vs. 16.8 ± 2.8 vs. 18.3 ± 1.8%; P < 0.001 for all]. On multivariable logistic regression analysis, endocardial LS was independently associated to symptoms (P = 0.012), together with indexed left atrial volume (P = 0.006) and LV concentric remodelling (P = 0.044). During a mean follow-up of 22 months, 33 patients died of a cardiovascular event. On multivariable Cox-regression analysis, age (P = 0.029), brain natriuretic peptide values (P = 0.003), LV mass index (P = 0.0065), LV end-systolic volume (P = 0.012), and endocardial LS (P = 0.0057) emerged as independently associated with cardiovascular death. The best endocardial LS values associated with outcome was 20.6% (sensitivity 70%, specificity 52%, area under the curve = 0.626, P = 0.022). Endocardial LS (19.1 ± 3.3 vs. 20.7 ± 3.3, P = 0.02) but not epicardial LS (15.2 ± 2.8 vs. 15.9 ± 2.5, P = 0.104) also predicted the outcome in patients who were initially asymptomatic. CONCLUSION: In patients with severe AS, LS impairment involves all myocardial layers and is more prominent in the advanced phases of the disease, when the symptoms occur. In this setting, the endocardial LS is independently associated with symptoms and patient outcome. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Ilardi, F.; Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman ,Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium, Department of Advanced Biomedical Sciences, University Federico II of Via S. Pansini, Naples, 80131, Italy

MARCHETTA, Stella ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs

MARTINEZ, Christophe ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Cardiologie interventionnelle

SPRYNGER, Muriel ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Angéiologie

ANCION, Arnaud ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Insuffisance cardiaque - Transplantation

Manganaro, R.; Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman ,Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium

Sugimoto, T.; Department of Clinical Laboratory, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan

Tsugu, T.; Department of Cardiology and Radiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman ,Domaine Universitaire du Sart Tilman - B.35, 4000 Liège, Belgium, Department of Cardiology, School of Medicine, Keio UniversityTokyo 160-8582, Japan

Postolache, Adriana ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de cardiologie

PIETTE, Caroline ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de cardiologie

More authors (6 more)

Language :

English

Title :

Impact of aortic stenosis on layer-specific longitudinal strain: relationship with symptoms and outcome

Publication date :

2020

Journal title :

European Heart Journal. Cardiovascular Imaging

ISSN :

2047-2404

eISSN :

2047-2412

Publisher :

NLM (Medline)

Volume :

Issue :

Pages :

408-416

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 13 February 2021

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