Sarrazyn Camille, Galloo Xavier, Meucci Maria Chiara, Butcher Steele C, Hirsawa Kensuke, Myagmardorj Rinchyenkhand, van der Kley Frank, De Backer Tine, Bax Jeroen J, Ajmone Marsan Nina
Department of Cardiology, Leiden University Medical Center, 2300ZA Leiden, The Netherlands.
Department of Cardiology, Ghent University Hospital, 9000 Gent, Belgium.
J Cardiovasc Dev Dis. 2024 Mar 13;11(3):90. doi: 10.3390/jcdd11030090.
(1) Background: Left ventricular global longitudinal (LVGLS) and right ventricular free wall strain (RVFWS) demonstrated separate prognostic values in patients with severe aortic stenosis (AS). However, studies evaluating the combined assessment of LVGLS and RVFWS have shown contradictory results. This study explored the prognostic value of combining LVGLS and RVFWS in a large group of severe AS patients referred for transcatheter aortic valve implantation. (2) Methods: Patients were classified into three groups: preserved (LVGLS ≥ 15% AND RVFWS > 20%), single-ventricle impaired (LVGLS < 15% OR RVFWS ≤ 20%), or biventricular-impaired strain group (LVGLS < 15% AND RVFWS ≤ 20%). The cut-off values were based on previously published data and spline analyses. The endpoint was all-cause mortality. (3) Results: Of the 712 patients included (age 80 ± 7 years, 53% men), 248 (35%) died. The single-ventricle impaired and biventricular-impaired (vs. preserved) strain groups showed significantly lower 5-year survival rates (68% and 55% vs. 77%, respectively, < 0.001). Through multivariable analysis, single-ventricle impaired (HR 1.762; 95% CI: 1.114-2.788; = 0.015) and biventricular-impaired strain groups (HR 1.920; 95% CI: 1.134-3.250; = 0.015) were independently associated with all-cause mortality. These findings were confirmed with a sensitivity analysis in patients with preserved LV ejection fraction. (4) Conclusions: In patients with severe AS, biventricular strain allows better risk stratification, even if LV ejection fraction is preserved.
(1) 背景：左心室整体纵向应变（LVGLS）和右心室游离壁应变（RVFWS）在重度主动脉瓣狭窄（AS）患者中显示出不同的预后价值。然而，评估LVGLS和RVFWS联合评估的研究结果相互矛盾。本研究探讨了在一大组接受经导管主动脉瓣植入术的重度AS患者中，联合LVGLS和RVFWS的预后价值。(2) 方法：患者分为三组：保留组（LVGLS≥15%且RVFWS>20%）、单心室功能受损组（LVGLS<15%或RVFWS≤20%）或双心室功能受损应变组（LVGLS<15%且RVFWS≤20%）。截断值基于先前发表的数据和样条分析。终点为全因死亡率。(3) 结果：纳入的712例患者（年龄80±7岁，53%为男性）中，248例（35%）死亡。单心室功能受损和双心室功能受损（与保留组相比）应变组的5年生存率显著较低（分别为68%和55%，而保留组为77%，<0.001）。通过多变量分析，单心室功能受损组（HR 1.762；95%CI：1.114 - 2.788；P = 0.015）和双心室功能受损应变组（HR 1.920；95%CI：1.134 - 3.250；P = 0.015）与全因死亡率独立相关。这些发现通过对左心室射血分数保留患者的敏感性分析得到证实。(4) 结论：在重度AS患者中，即使左心室射血分数保留，双心室应变也能更好地进行风险分层。
