The value of global longitudinal strain and galectin-3 for predicting cardiovascular events in patients with severe aortic stenosis.

Abstract

Left ventricular global longitudinal strain (GLS) was shown to predict outcomes after valve replacement in patientswith aortic stenosis (AS). In the current study, we aimed to test the combined use of GLS and a marker of fibrosis - Galectin-3 - for predicting major cardiovascular adverse events (MACEs) in patients with severe AS. Weconducted a prospective study on 42 patients with severe AS and 42 volunteers. Patient evaluation included biochemistry tests,electrocardiogram, 24-hour Holter monitoring, the 6-minute walk test, and echocardiography. Outcomes of AS patients weredefined as the composite of MACEs - sudden cardiac death, non-fatal myocardial infarction, sustained ventricular arrhythmias,atrial arrhythmias, and hospitalization for heart failure. Patients with severe AS had lower GLS, and increasedlevels of both biomarkers compared to the control group. Both biomarkers correlated to echocardiographic parameters such asleft ventricular (LV) mass index, relative wall thickness, GLS, as well as with the 6-minute walk test distance, and glomerularfiltration rate (eGFR). GLS and NT-proBNP predicted MACEs reasonably well, while Galectin-3 did not, after adjustments forconfounding factors. Kaplan-Meier analysis showed that the probability of freedom from MACEs was significant in patientswho exhibited lower GLS [HR 2.73 (95% CI 1.01-7.53), p<0.05] and higher levels of NT-proBNP [HR 5.22 (95% CI 1.85-14.51), p=0.001]. Among tested parameters, GLS and NT-proBNP were the most reliable predictors of MACEsin patients with severe AS, while Galectin-3 performed more poorly.