Cionca Carmen, Zlibut Alexandru, Agoston Renata, Agoston-Coldea Lucia, Orzan Rares Ilie, Mocan Teodora
Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Department Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Biomedicines. 2024 Sep 14;12(9):2104. doi: 10.3390/biomedicines12092104.
Aortic valve stenosis (AS) is the most common degenerative valvular heart disease, significantly impacting the outcome. Current guidelines recommend valve replacement only for symptomatic patients, but advanced cardiovascular imaging, particularly cardiac magnetic resonance (CMR), may refine these recommendations. Feature-tracking CMR (FT-CMR) effectively assesses left ventricular (LV) strain and shows promise in predicting major adverse cardiovascular events (MACEs), though data on AS are limited. This study explored the role of CMR-derived LV strain in predicting MACEs occurrence in patients with severe AS. We prospectively assessed 84 patients with severe AS and 84 matched controls. Global longitudinal (GLS), circumferential (GCS), and radial strain (GRS) were evaluated using FT-CMR. A composite endpoint-cardiac death, ventricular tachyarrhythmias, and heart failure hospitalization-was analyzed over a median follow-up of 31 months. GLS was considerably reduced in AS patients (-15.8% vs. -19.7%, < 0.001) and significantly predicted MACEs (HR = 1.24, = 0.002) after adjusting for LVEF, 6 min walk distance, native T1, and late gadolinium enhancement. This underscores GLS's unique and robust predictive capability for MACEs in severe AS patients. Kaplan-Meier curves and ROC analysis both showed that GLS had the highest predictive performance for MACEs, with an AUC of 0.857. : GLS provided independent incremental predictive value for outcome.
主动脉瓣狭窄（AS）是最常见的退行性心脏瓣膜病，对病情转归有重大影响。当前指南建议仅对有症状的患者进行瓣膜置换，但先进的心血管成像技术，尤其是心脏磁共振成像（CMR），可能会完善这些建议。特征追踪CMR（FT-CMR）能有效评估左心室（LV）应变，并在预测主要不良心血管事件（MACE）方面显示出前景，不过关于AS的相关数据有限。本研究探讨了CMR衍生的LV应变在预测重度AS患者发生MACE中的作用。我们前瞻性地评估了84例重度AS患者和84例匹配的对照。使用FT-CMR评估整体纵向应变（GLS）、圆周应变（GCS）和径向应变（GRS）。在中位随访31个月期间，分析了一个复合终点——心源性死亡、室性快速心律失常和心力衰竭住院情况。AS患者的GLS显著降低（-15.8%对-19.7%，<0.001），在调整左心室射血分数（LVEF）、6分钟步行距离、固有T1和延迟钆增强后，显著预测了MACE（风险比[HR]=1.24，P=0.002）。这凸显了GLS在重度AS患者中对MACE具有独特且强大的预测能力。Kaplan-Meier曲线和ROC分析均表明，GLS对MACE的预测性能最高，曲线下面积（AUC）为0.857。GLS为结局提供了独立的增量预测价值。
