Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/20092
Title: Distribution and Prognostic Significance of Left Ventricular Global Longitudinal Strain in Asymptomatic Significant Aortic Stenosis: An Individual Participant Data Meta-Analysis.
Authors: Magne, Julien;Cosyns, Bernard;Popescu, Bogdan A;Carstensen, Helle G;Dahl, Jordi;Desai, Milind Y;Kearney, Leighton G;Lancellotti, Patrizio;Marwick, Thomas H;Sato, Kimi;Takeuchi, Masaaki;Zito, Concetta;Casalta, Anne-Claire;Mohty, Dania;Piérard, Luc;Habib, Gilbert;Donal, Erwan
Affiliation: Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
UZ Brussel-CVHZ, Brussels, Belgium
Baker Heart and Diabetes Institute, Melbourne, Australia
CHU Limoges, Hôpital Dupuytren, Service Cardiologie, INSERM 1094, Limoges, France
University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu," Bucharest, Romania
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
Department of Cardiology, Odense University Hospital, Odense, Denmark
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU Sart Tilman, Liège, Belgium
Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Department of Laboratory and Transfusion Medicine, Hopital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy..
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
CHU Limoges, Hôpital Dupuytren, Service Cardiologie, INSERM 1094, Limoges, France
University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU Sart Tilman, Liège, Belgium
Aix-Marseille Université, APHM, La Timone Hospital, Cardiology Department, Marseille, France
Cardiologie et CIC-IT 1414, CHU Rennes; LTSI, Inserm 1099, University Rennes 1, Rennes, France
Gruppo Villa Maria Care and Research, Anthea, Bari, Italy
Issue Date: Jan-2019
Citation: JACC. Cardiovascular imaging 2019; 12(1): 84-92
Abstract: In this individual participant data meta-analysis on left ventricular global longitudinal strain (LVGLS), our objective was to: 1) describe its distribution; 2) identify the most predictive cutoff values; and 3) assess its impact on mortality in asymptomatic patients with significant aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF). The evidence supporting the prognostic role of LVGLS in asymptomatic patients with AS has been obtained from several relatively small studies. A literature search was performed for studies published between 2005 and 2017 without language restriction according to the following criteria: "aortic stenosis" AND "longitudinal strain." The corresponding authors of selected studies were contacted and invited to share their data that we computerized in a specific database. The primary endpoint was all-cause mortality. Among the 10 studies included, 1,067 asymptomatic patients with significant AS and LVEF >50% were analyzed. The median of LVGLS was 16.2% (from 5.6% to 30.1%). There were 91 deaths reported during follow-up with median of 1.8 (0.9 to 2.8) years, resulting in a pooled crude mortality rate of 8.5%. The LVGLS performed well in the prediction of death (area under the curve: 0.68). The best cutoff value identified was LVGLS of 14.7% (sensitivity, 60%; specificity, 70%). Using random effects model, the risk of death for patients with LVGLS <14.7% is multiplied by >2.5 (hazard ratio: 2.62; 95% confidence interval: 1.66 to 4.13; p < 0.0001), without significant heterogeneity between studies (I2 = 18.3%; p = 0.275). The relationship between LVGLS and mortality remained significant in patients with LVEF ≥60% (p = 0.001). This individual participant data meta-analysis demonstrates that in asymptomatic patients with significant AS and normal LVEF, impaired LVGLS is associated with reduced survival. These data emphasize the potential usefulness of LVGLS for risk stratification and management of these patients.
URI: http://ahro.austin.org.au/austinjspui/handle/1/20092
DOI: 10.1016/j.jcmg.2018.11.005
PubMed URL: 30621997
Type: Journal Article
Subjects: aortic valve stenosis
left ventricular global longitudinal strain
meta-analysis
mortality
Appears in Collections:Journal articles

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