Department of Medicine, The University of Melbourne, Austin Health, Victoria, Australia.
Eur Heart J Cardiovasc Imaging. 2012 Oct;13(10):827-33. doi: 10.1093/ehjci/jes115. Epub 2012 Jun 26.
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.
评估整体纵向应变（GLS）在主动脉瓣狭窄（AS）患者中的能力，以：（i）检测亚临床左心室（LV）功能障碍（LV射血分数[LVEF]≥50%的患者）；（ii）预测全因死亡率和主要不良心脏事件（MACE）（所有患者）；（iii）提供比当前风险标志物更具增量预后信息。
146 例 AS 患者和 12 例年龄匹配的对照组接受基线超声心动图检查，以评估 AS 严重程度、常规 LV 参数和通过斑点追踪超声心动图评估 GLS。记录基线人口统计学、症状严重程度分级和合并症。通过医院记录审查和受试者/医生访谈确定结局。平均年龄为 75±11 岁，62%为男性。基线主动脉瓣（AV）面积为 1.0±0.4cm2，LVEF 为 59±11%。在 LVEF 正常的患者（n=122）中，基线 GLS 为对照组-21±2%，轻度 AS-18±3%，中度 AS-17±3%，重度 AS-15±3%（P<0.001）。GLS 与 LV 质量指数、LVEF、AS 严重程度和症状分级相关（P<0.05）。在中位随访 2.1 年（四分位距：1.8-2.4）期间，有 20 例死亡和 101 例 MACE。GLS（每%）的未调整危险比（HR）为全因死亡率（HR：1.42，P<0.001）和 MACE（HR：1.09，P<0.001）。在调整临床和超声心动图变量后，GLS 仍然是 AS 患者全因死亡率的独立强预测因子（HR：1.38，P<0.001）。
GLS 可检测亚临床功能障碍，并在传统风险标志物（包括血流动力学严重程度、症状分级和 LVEF）的基础上，为 AS 患者提供额外的预后价值。将 GLS 纳入风险模型可能会改善对 AV 置换最佳时机的识别。
