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

Statistics

Number of views

169 (9 by ULiège)

Number of downloads

287 (7 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

OpenAlex citations

Bibliography

Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006;368: 1005-11.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, 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:e1159-95.
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739-91.
Dulgheru R, Pibarot P, Sengupta PP, Piérard LA, Rosenhek R, Magne J et al. Multimodality imaging strategies for the assessment of aortic stenosis: viewpoint of the Heart Valve Clinic International Database (HAVEC) Group. Circ Cardiovasc Imaging 2016;9:e004352.
Redfors B, Pibarot P, Gillam LD, Burkhoff D, Bax JJ, Lindman BR et al. Stress testing in asymptomatic aortic stenosis. Circulation 2017;135:1956-76.
Yang H, Sun JP, Lever HM, Popovic ZB, Drinko JK, Greenberg NL et al. Use of strain imaging in detecting segmental dysfunction in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2003;16:233-9.
Smedsrud MK, Sarvari S, Haugaa KH, Gjesdal O, Ørn S, Aaberge L et al. Duration of myocardial early systolic lengthening predicts the presence of significant coronary artery disease. J Am Coll Cardiol 2012;60:1086-93.
Lancellotti P, Donal E, Magne J, O'Connor K, Moonen ML, Cosyns B et al. Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study. Eur J Echocardiogr 2010;11:537-43.
Thavendiranathan P, Poulin F, Lim KD, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardio-toxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol 2014;63:2751-68.
Davin L, Nchimi A, Ilardi F, Dulgheru R, Marchetta S, Gach O et al. Epicardial adipose tissue and myocardial fibrosis in aortic stenosis relationship with symptoms and outcomes: a study using cardiac magnetic resonance imaging. JACC Cardiovasc Imaging 2019;12:213-4.
Fung MJ, Leung DY, Thomas L. Differential myocardial fibre involvement by strain analysis in patients with aortic stenosis. Heart Lung Circ 2018;27:1357-67.
Ozawa K, Funabashi N, Kobayashi Y. Left ventricular myocardial strain gradient using a novel multi-layer transthoracic echocardiography technique positively correlates with severity of aortic stenosis. Int J Cardiol 2016;221: 218-26.
Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2017; 18:254-75.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al. Recommendations for the evaluation of left ventricular diastolic function by Echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016;17:1321-60.
Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L et al. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2018;19: 630-8.
Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 2011;12:167-205.
Sugimoto T, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K et al. Echocardiographic reference ranges for normal left ventricular 2D strain: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017;18:833-40.
Alcidi GM, Esposito R, Evola V, Santoro C, Lembo M, Sorrentino R et al. Normal reference values of multilayer longitudinal strain according to age decades in a healthy population: a single-centre experience. Eur Heart J Cardiovasc Imaging 2017;19:1390-6.
Manganaro R, Marchetta S, Dulgheru R, Ilardi F, Sugimoto T, Robinet S et al. Echocardiographic reference ranges for normal noninvasive myocardial work indices: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2019; 20:582-90.
Weidemann F, Herrmann S, Störk S, Niemann M, Frantz S, Lange V et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation 2009;120:577-84.
Treibel TA, López B, González A, Menacho K, Schofield RS, Ravassa S et al. Reappraising myocardial fibrosis in severe aortic stenosis: an invasive and non-invasive study in 133 patients. Eur Heart J 2018;39:699-709.
Hoffmann R, Altiok E, Friedman Z, Becker M, Frick M. Myocardial deformation imaging by two-dimensional speckle-tracking echocardiography in comparison to late gadolinium enhancement cardiac magnetic resonance for analysis of myocar-dial fibrosis in severe aortic stenosis. Am J Cardiol 2014;114:1083-8.
Ng AC, Delgado V, Bertini M, Antoni ML, van Bommel RJ, van Rijnsoever EP et al. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: a two-dimensional speckle tracking analysis. Eur Heart J 2011;32:1542-50.
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.
Ng ACT, Prihadi EA, Antoni ML, Bertini M, Ewe SH, Ajmone Marsan N et al. Left ventricular global longitudinal strain is predictive of all-cause mortality independent of aortic stenosis severity and ejection fraction. Eur Heart J Cardiovasc Imaging 2018;19:859-67.
Donal E, Thebault C, O'Connor K, Veillard D, Rosca M, Pierard L et al. Impact of aortic stenosis on longitudinal myocardial deformation during exercise. Eur J Echocardiogr 2011;12:235-41.
Vollema EM, Sugimoto T, Shen M, Tastet L, Ng ACT, Abou R et al. Association of left ventricular global longitudinal strain with asymptomatic severe aortic stenosis natural course and prognostic value. JAMA Cardiol 2018;3:839-47.
Magne J, Cosyns B, Popescu BA, Carstensen HG, Dahl J, Desai MY et al. Distribution and prognostic significance of left ventricular global longitudinal strain in asymptomatic significant aortic stenosis: an individual participant data meta-analysis. Eur Heart J Cardiovasc Imaging 2019;12:84-92.
Dahl JS, Magne J, Pellikka PA, Donal E, Marwick TH. Assessment of subclinical left ventricular dysfunction in aortic stenosis. JACC Cardiovasc Imaging 2019;12: 163-71.
Garcia D, Camici PG, Durand LG, Rajappan K, Gaillard E, Rimoldi OE et al. Impairment of coronary flow reserve in aortic stenosis. J Appl Physiol 2009;106: 113-21.
Rajappan K, Rimoldi OE, Dutka DP, Ariff B, Pennell DJ, Sheridan DJ et al. Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries. Circulation 2002;105: 470-6.
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 valvular, arterial and ventricular interplay. Heart 2010;96:1364-71.
Cho EJ, Park SJ, Kim EK, Lee GY, Chang SA, Choi JO et al. Effects of increased left ventricular wall thickness on the myocardium in severe aortic stenosis with normal left ventricular ejection fraction: two-and three-dimensional multilayer speckle tracking echocardiography. Echocardiography 2017;34:511-22.
Lancellotti P, Magne J, Dulgheru R, Clavel MA, Donal E, Vannan MA et al. Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics. JAMA Cardiol 2018;3:1060-8.