RT Journal Article
SR Electronic
T1 Right ventricular longitudinal strain for risk stratification in low-flow, low-gradient aortic stenosis with low ejection fraction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 548
OP 554
DO 10.1136/heartjnl-2015-308309
VO 102
IS 7
A1 Abdellaziz Dahou
A1 Marie-Annick Clavel
A1 Romain Capoulade
A1 Philipp Emanuel Bartko
A1 Julien Magne
A1 Gerald Mundigler
A1 Jutta Bergler-Klein
A1 Ian Burwash
A1 Julia Mascherbauer
A1 Henrique B Ribeiro
A1 Kim O'Connor
A1 Helmut Baumgartner
A1 Mario Sénéchal
A1 Jean G Dumesnil
A1 Raphael Rosenhek
A1 Patrick Mathieu
A1 Eric Larose
A1 Josep Rodés-Cabau
A1 Philippe Pibarot
YR 2016
UL http://heart.bmj.com/content/102/7/548.abstract
AB Background Left ventricular global longitudinal strain (LVLS) is a powerful predictor of outcome in patients with low-flow, low-gradient aortic stenosis (LF-LG AS) and low LV ejection fraction (LVEF). However, the impact of right ventricular (RV) function on the outcome of these patients remains unknown.Objectives The aim of this study was to examine the impact of RV function as evaluated by RV free wall longitudinal strain (RVLS) on mortality in patients with LF-LG AS and low LVEF.Methods 211 patients with LF-LG AS (mean gradient <40 mm Hg and indexed aortic valve area (AVA) ≤0.6 cm2/m2) and low LVEF (≤40%)) were prospectively recruited in the True or Pseudo-severe Aortic Stenosis study. AS severity was assessed using the projected AVA (AVAproj) at normal flow rate. Among the 211 patients, 128 had RVLS measurement available at rest and were included in this analysis. RVLS measurement at dobutamine stress echocardiography (DSE) was available in 58 of the 128 patients.Results Two-year survival was lower in patients with RVLS<|13|% (53%±9%) compared with those with RVLS>|13|% (69%±5%) (p=0.04). In multivariable Cox analysis stratified for the type of treatment (aortic valve replacement vs conservative) and adjusted for age, AS severity, previous myocardial infarction and LVLS, rest RVLS<|13|% (HR=2.70; 95% CI 1.19 to 6.11; p=0.018) was independently associated with all-cause mortality. RVLS had incremental prognostic value over baseline risk factors and LVLS (χ2=20.13 vs 13.56; p=0.01). Reduced stress RVLS was also associated with increased risk of mortality (stress RVLS<|14|%: HR=2.98; 95% CI 1.30 to 6.52; p=0.01). In multivariable Cox analysis, stress RVLS<|14|% remained independently associated with mortality (HR=2.94; 95% CI 1.23 to 7.02; p=0.015). After further adjustment for rest RVLS, stress RVLS<|14|% remained independently associated with mortality (HR=3.29; 95% CI 1.17 to 9.25; p=0.024), whereas rest RVLS was not (p>0.05).Conclusions In this series of patients with LF-LG AS and low LVEF, reduced RVLS was independently associated with increased risk of mortality. Furthermore, stress RVLS provided incremental prognostic value beyond that obtained from rest RVLS. Thus, RVLS measurement at rest and at DSE may be helpful to enhance risk stratification in this high-risk population.Trial registration number NCT01835028; Results.