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Title: Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis.
Austin Authors: Kearney, Leighton G ;Lu, K;Ord, M;Patel, Sheila K ;Profitis, K;Matalanis, George ;Burrell, Louise M ;Srivastava, Piyush M 
Affiliation: Department of Medicine, The University of Melbourne, Austin Health, Victoria, Australia
Issue Date: 26-Jun-2012
Publication information: European Heart Journal Cardiovascular Imaging 2012; 13(10): 827-33
Abstract: To assess the capacity of global longitudinal strain (GLS) in patients with aortic stenosis (AS) to (i) detect the subclinical left ventricular (LV) dysfunction [LV ejection fraction (LVEF) ≥50% patients]; (ii) predict all-cause mortality and major adverse cardiac events (MACE) (all patients), and (iii) provide incremental prognostic information over current risk markers.Patients with AS (n = 146) and age-matched controls (n = 12) underwent baseline echocardiography to assess AS severity, conventional LV parameters and GLS via speckle tracking echocardiography. Baseline demographics, symptom severity class and comorbidities were recorded. Outcomes were identified via hospital record review and subject/physician interview. The mean age was 75 ± 11, 62% were male. The baseline aortic valve (AV) area was 1.0 ± 0.4 cm(2) and LVEF was 59 ± 11%. In patients with a normal LVEF (n = 122), the baseline GLS was controls -21 ± 2%, mild AS -18 ± 3%, moderate AS -17 ± 3% and severe AS -15 ± 3% (P< 0.001). GLS correlated with the LV mass index, LVEF, AS severity, and symptom class (P< 0.05). During a median follow-up of 2.1 (inter-quartile range: 1.8-2.4) years, there were 20 deaths and 101 MACE. Unadjusted hazard ratios (HRs) for GLS (per %) were all-cause mortality (HR: 1.42, P< 0.001) and MACE (HR: 1.09, P< 0.001). After adjustment for clinical and echocardiographic variables, GLS remained a strong independent predictor of all-cause mortality (HR: 1.38, P< 0.001).GLS detects subclinical dysfunction and has incremental prognostic value over traditional risk markers including haemodynamic severity, symptom class, and LVEF in patients with AS. Incorporation of GLS into risk models may improve the identification of the optimal timing for AV replacement.
Gov't Doc #: 22736713
DOI: 10.1093/ehjci/jes115
Journal: European heart journal cardiovascular Imaging
Type: Journal Article
Subjects: Aged
Aged, 80 and over
Analysis of Variance
Aortic Valve Stenosis.mortality.pathology.ultrasonography
Biological Markers
Case-Control Studies
Prospective Studies
Risk Factors
Severity of Illness Index
Stroke Volume
Ventricular Function, Left
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