Prognostic value of left ventricular global longitudinal strain in patients with severe aortic stenosis for transcatheter aortic valve implantation-related morbidity and mortality: a meta-analysis

Abstract

Abstract Aims Current methods, including left ventricular ejection fraction (LVEF), demonstrate limited prognostic value for post-Transcatheter Aortic Valve Implantation (TAVI) outcomes. Studies elaborating on LV global longitudinal strain (GLS) showed promising results, but are often underpowered. Purpose This meta-analysis aims to evaluate the prognostic value of preprocedural global longitudinal strain (GLS) for post-TAVI mortality and morbidity. Methods A systematic search was conducted in PubMed, Embase and Web of Science from 2001 to 2021. All studies that comprised patients with severe aortic stenosis who underwent TAVI and investigated the association between preprocedural speckle-tracking-derived GLS and clinical outcomes, were included. An inversely-weighted random effects meta-analysis was adopted to investigate the association between preprocedural GLS vs primary (i.e. all-cause mortality) and secondary (i.e. major cardiovascular events [MACE]) post-TAVI outcomes. Results Of the 1,057 identified records, 12 were eligible, all of which had a low-to-moderate risk of bias (Newcastle-Ottawa scale). On average, the 2,068 unique patients demonstrated preserved ejection fraction but impaired longitudinal function (mean LVEF 52.2±4.4%, GLS −13.5±1.6%). Patients with a lower GLS had a higher all-cause mortality (pooled hazard ratio (HR) 1.99 [95% confidence interval (CI): 1.59, 2.50]) and MACE (1.26 [95% CI: 1.08, 1.46]) risk compared to patients with higher GLS. In addition, each 1% decrease of GLS was associated with an increased postprocedural mortality (HR 1.06 [95% CI: 1.03, 1.08]) and MACE risk (pooled HR 1.08 [95% CI: 1.01, 1.15]). Conclusion Preprocedural GLS was significantly associated with post-TAVI mortality and morbidity. This suggests a potential clinically important role of pre-TAVI evaluation of GLS for risk stratification of patients with severe aortic stenosis. Funding Acknowledgement Type of funding sources: Public hospital(s).