Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Department of Cardiology, Princess Alexandra Hospital, Centre for Advanced Imaging, The University of Queensland, Australia.
Eur Heart J Cardiovasc Imaging. 2018 Aug 1;19(8):859-867. doi: 10.1093/ehjci/jex189.
Left ventricular (LV) global longitudinal strain (GLS) may identify subclinical myocardial dysfunction in patients with aortic stenosis (AS). The aims of the present retrospective single centre study were to determine the independent prognostic value of LV GLS over LV ejection fraction (EF) and the role of LV GLS to further risk stratify severe AS patients before aortic valve replacement.
A total of 688 patients (median age 72 years, 61.2% men) with mild (n = 130), moderate (n = 264) and severe AS (n = 294) were included. LV GLS was determined by 2D speckle tracking echocardiography. A total of 114 (16.6%) patients died before surgery during the study. When patients with severe AS and normal LVEF were dichotomized based on the median LV GLS value (-14.0%), patients with normal LVEF and 'preserved' LV GLS of ≤ -14% had significantly higher survival than patients with 'impaired' LV GLS of > -14%. There was no difference in survival between patients with normal LVEF but 'impaired' LV GLS ( > -14%) and patients with impaired LVEF (log-rank P = 0.34). LV GLS was independently associated with all-cause mortality on multivariable Cox regression analysis (hazard ratio 1.17, 95% confidence interval 1.09-1.26; P < 0.001).
LV GLS is independently associated with all-cause mortality in AS patients. It can further risk stratify severe AS patients and may influence the optimal timing of aortic valve replacement.
左心室（LV）整体纵向应变（GLS）可在主动脉瓣狭窄（AS）患者中识别亚临床心肌功能障碍。本回顾性单中心研究的目的是确定 LV GLS 对 LV 射血分数（EF）的独立预后价值，以及 LV GLS 在主动脉瓣置换术前行进一步风险分层严重 AS 患者的作用。
共纳入 688 例轻度（n=130）、中度（n=264）和重度（n=294）AS 患者。LV GLS 通过二维斑点追踪超声心动图确定。共有 114 例（16.6%）患者在研究期间手术前死亡。当重度 AS 且 EF 正常的患者根据 LV GLS 中位数（-14.0%）分为两部分时，EF 正常且 GLS 值≤-14%的患者生存率显著高于 GLS 值>-14%的患者。EF 正常但 GLS 值>-14%的患者与 EF 受损的患者（log-rank P=0.34）之间生存率无差异。LV GLS 在多变量 Cox 回归分析中与全因死亡率独立相关（危险比 1.17，95%置信区间 1.09-1.26；P<0.001）。
LV GLS 与 AS 患者的全因死亡率独立相关。它可以进一步对严重 AS 患者进行风险分层，并可能影响主动脉瓣置换术的最佳时机。
