The Prognostic Value of Myocardial Deformation in Patients with Congenital Aortic Stenosis

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Abstract

Aims: To assess the prognostic value of left ventricular (LV) global longitudinal strain (GLS) and global longitudinal early diastolic strain rate (GLSre) with regard to cardiovascular events, as congenital aortic stenosis (AoS) is associated with significant mortality and morbidity but predictors for clinical outcome are scarce. Strain analysis provides a robust and reproducible method for early detection of LV dysfunction, which might be of prognostic value. Methods: This prospective study, included clinically stable patients with congenital AoS between 2011– 2013. LV GLS and GLSre was performed in the apical 4, 3 and 2-chamber views using Tomtec software. The end-point was a composite of death, heart failure, hospitalization, arrhythmia, thrombo-embolic events and re-inter-vention. Results: In total 138 patients were included (33[26–43] years, 86(62%) male), NYHA class I: 134(97%). Mean LV GLS was –15.3 ± 3.2%, GLSre 0.66 ± 0.18 s–1. Both correlated with NT-proBNP, LV volumes and ejection fraction (strongest LV GLS with LV EF: r –0.539, p < 0.001, strongest LV GLSre with age: r –0.376, p < 0.001). During median follow-up of 5.9[5.5–6.2] years, the endpoint occurred in 53(38%) patients: 4 patients died, 9 developed heart failure, 22 arrhythmias, 8 thrombo-embolic events and 35 re-interventions. Both LV GLS (stan-dardized HR (sHR 0.62(95%CI 0.47–0.81) and GLSre (sHR 0.62(95%CI 0.47–0.83) were associated with the end-point. Additional multivariable analysis showed that both GLS and GLSre were associated independent of left atrial volume, NT-proBNP and prior re-interventions. Conclusion: Left ventricular GLS and GLSre are reduced in adult patients with congenital AoS. Both markers are associated with adverse cardiac events and have clear clinical relevance.

Original languageEnglish
Pages (from-to)221-232
Number of pages12
JournalCongenital Heart Disease
Volume16
Issue number3
DOIs
Publication statusPublished - 2 Mar 2021

Bibliographical note

Funding Information:
Funding Statement: This study was supported by a grant from the Erasmus Thorax Foundation.

Publisher Copyright:
© 2021, Tech Science Press. All rights reserved.

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