115 Relation between global longitudinal strain in patients with aortic stenosis: relation with severity and symptoms

Abstract

Patient with aortic stenosis (AS) and reduced ejection fraction (EF) should be promptly operated on. Global longitudinal strain (GLS) has been proposed as a subtle subclinical marker of left ventricular (LV) systolic dysfunction and a potential prognostic factor in asymptomatic patients with AS. However, the relation between GLS, AS severity and symptoms has not been fully evaluated. Eighty-six patients (74 ± 11 years, 35% female) with at least mild AS were prospectively enrolled. Clinical evaluation included the assessment of symptoms (angina, syncope, and dyspnea) and a physical examination. All patients had a comprehensive transthoracic echocardiography (TTE). GLS was measured offline using a dedicated station and software (EchoPac, General Electric) blinded of any clinical and TTE information. Forty-three patients (43%) were asymptomatic. AS range was wide with a mean aortic valve area (AVA) of 1.06 ± 0.42 cm 2 [0.33–2.3] and 55 patients (64%) had a severe AS (AVA<1 cm 2 ). Mean EF was 63 ± 6 and 8 patients (9%) and a reduced EF (<60%). We divided our population into 4 subgroups, asymptomatic non-severe AS (group 1), asymptomatic severe AS and normal EF (group 2), symptomatic severe AS and normal EF (group 3) and symptomatic severe AS and reduced EF (group 4). Overall GLS decreased from group 1 to 4 (p < 0.0001) (Table) and a correlation between AS severity and GLS was observed (r = −0.40, p = 0.0002). However, GLS was not significantly different between patients with symptomatic and asymptomatic severe AS (group 2 and 3, p = 0.32). In the present study we show that GLS was significantly correlated to AS severity and reduced in patients impaired EF. However, GLS was not different between patients with symptomatic and asymptomatic severe AS. These preliminary data deserve further confirmation but raise caution regarding the potential prognostic value of GLS in patients with asymptomatic AS. Group 1 (n = 31) Group 2 (n = 12) Group 3 (n = 35) Group 4 (n = 8) P between groups GLS −19,1 ± 2.9 −18,7 ± 4.6 −17.5 ± 3.2 −12.5 ± 4.0 <0.0001