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Original research
Prognostic value of automated longitudinal strain measurements in asymptomatic aortic stenosis
  1. Tetsuji Kitano1,
  2. Yosuke Nabeshima2,
  3. Kazuaki Negishi3,
  4. Masaaki Takeuchi4
  1. 1 Department of Cardiology and Nephrology, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
  2. 2 Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
  3. 3 Nepean Clinical School, Charles Perkins Centre Nepean, The University of Sydney, Penrith, New South Wales, Australia
  4. 4 Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
  1. Correspondence to Dr Tetsuji Kitano, Department of Cardiology and Nephrology, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan; syuukyuu1986{at}


Objective Two-dimensional (2D) longitudinal strain (LS) predicts cardiac events in aortic stenosis (AS). However, it requires manual editing, which affects its accuracy and reliability. We investigated whether left ventricular (LV), left atrial (LA) and right ventricular (RV) LSs using fully automated 2D strain software provide useful prognostic information in asymptomatic AS.

Methods We performed LS analyses in 340 asymptomatic patients with AS using novel, fully automated 2D strain analytical software (AutoStrain, Philips) to obtain LV global LS (LVGLS), LALS, RV free wall LS and RVLS. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalisation, myocardial infarction or ventricular tachyarrhythmia.

Results During a median of 24 months follow-up, 46 patients reached a primary end point. 62 patients had aortic valve surgery. All four LSs were significantly associated with the primary end point using univariate analysis (HR 0.821 to 0.951, p<0.05). Multivariate analysis revealed that LVGLS (HR 0.873 to 0.888, p<0.05) remained significantly associated with cardiac events, even after adjusting haemodynamic measures of AS severity and LV ejection fraction. Kaplan-Meier survival curve showed median values of both LVGLS (cut-off: 15.1%) and LALS (cut-off: 22.3%) provide a significant difference in cardiac event rate (3-year event-free rate; LVGLS: 89% vs 76%, p=0.002; LALS: 89% vs 76%, p=0.001). Classification and regression-tree analysis, including four LSs, clinical characteristics and traditional echocardiographic parameters, selected LVGLS and E/ε’ for stratifying a high-risk group of patients with cardiac events.

Conclusions Fully automated 2D LS analysis, especially LVGLS provides useful prognostic information in asymptomatic AS.

  • aortic valve stenosis
  • echocardiography
  • outcome assessment
  • health care

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  • Contributors Conceptualisation: MT. Data curation: TK, YN, MT. Formal analysis: MT, KN, TK, YN. Investigation: TK, MT, YN, KN. Methodology: MT, KN, TK. Writing—original draft: TK, MT, YN.

  • Funding This study was supported by Philips Medical Systems.

  • Competing interests MT received research grant from Philips Medical Systems. KN is supported by a Fellowship (Award Reference No. 101868) from the National Heart Foundation of Australia. Other authors did not receive any grants from funding agencies in the public, commercial or not-for-profit sectors.

  • Patient consent for publication Not required.

  • Ethics approval This study protocol was approved by the local Ethics Committee of the University of Occupational and Environmental Health, School of Medicine (H29-169), but the requirement for written informed consent was waived due to the retrospective nature of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request to the corresponding author.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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