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Meta-Analysis
. 2023 Mar;16(3):332-341.
doi: 10.1016/j.jcmg.2023.01.005.

Prognostic Value of Preprocedural LV Global Longitudinal Strain for Post-TAVR-Related Morbidity and Mortality: A Meta-Analysis

Niels A Stens  1 , Odette van Iersel  2 , Max J P Rooijakkers  3 , Marleen H van Wely  3 , Robin Nijveldt  3 , Esmée A Bakker  2 , Laura Rodwell  4 , Anders L D Pedersen  5 , Steen H Poulsen  5 , Didrik Kjønås  6 , Jan Stassen  7 , Jeroen J Bax  8 , Felix C Tanner  9 , Stamatios Lerakis  10 , Sara Shimoni  11 , Frédéric Poulin  12 , Vera Ferreira  13 , Vlatka Reskovic Luksic  14 , Niels van Royen  3 , Dick H J Thijssen  15
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Free article
Meta-Analysis

Prognostic Value of Preprocedural LV Global Longitudinal Strain for Post-TAVR-Related Morbidity and Mortality: A Meta-Analysis

Niels A Stens et al. JACC Cardiovasc Imaging. 2023 Mar.
Free article

Abstract

Background: Left ventricular ejection fraction (LVEF) demonstrates limited prognostic value for post-transcatheter aortic valve replacement (TAVR) outcomes. Evidence regarding the potential role of left ventricular global longitudinal strain (LV-GLS) in this setting is inconsistent.

Objectives: The aim of this systematic review and meta-analysis of aggregated data was to evaluate the prognostic value of preprocedural LV-GLS for post-TAVR-related morbidity and mortality.

Methods: The authors searched PubMed, Embase, and Web of Science for studies investigating the association between preprocedural 2-dimensional speckle-tracking-derived LV-GLS and post-TAVR clinical outcomes. An inversely weighted random effects meta-analysis was adopted to investigate the association between LV-GLS vs primary (ie, all-cause mortality) and secondary (ie, major cardiovascular events [MACE]) post-TAVR outcomes.

Results: Of the 1,130 identified records, 12 were eligible, all of which had a low-to-moderate risk of bias (Newcastle-Ottawa scale). On average, 2,049 patients demonstrated preserved LVEF (52.6% ± 1.7%), but impaired LV-GLS (-13.6% ± 0.6%). Patients with a lower LV-GLS had a higher all-cause mortality (pooled HR: 2.01; 95% CI: 1.59-2.55) and MACE (pooled odds ratio [OR]: 1.26; 95% CI: 1.08-1.47) risk compared with patients with higher LV-GLS. In addition, each percentage point decrease of LV-GLS (ie, toward 0%) was associated with an increased mortality (HR: 1.06; 95% CI: 1.04-1.08) and MACE risk (OR: 1.08; 95% CI: 1.01-1.15).

Conclusions: Preprocedural LV-GLS was significantly associated with post-TAVR morbidity and mortality. This suggests a potential clinically important role of pre-TAVR evaluation of LV-GLS for risk stratification of patients with severe aortic stenosis. (Prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis undergoing Transcatheter Aortic Valve Implantation: a meta-analysis; CRD42021289626).

Keywords: aortic stenosis; echocardiography; morbidity; mortality; strain; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures Mr Stens was supported by a personally obtained grant from the Radboud University Medical Center. Dr Nijveldt has received grants from Philips Volcano and Biotronik for the iMODERN (iFR Guided Multi-vessel Revascularization During Percutaneous Coronary Intervention for Acute Myocardial Infarction) trial, educational fees from Sanofi Genzyme and Bayer, and has served as the vice president elect of the EACVI CMR section (unpaid). Dr Bax has served on the Speaker Bureau for Abbott and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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