Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 7:10:1252872.
doi: 10.3389/fcvm.2023.1252872. eCollection 2023.

Right vs. left ventricular longitudinal strain for mortality prediction after transcatheter aortic valve implantation

Neria E Winkler  1 , Shehab Anwer  1 , Kelly A Reeve  1   2 , Jonathan M Michel  1 , Albert M Kasel  1 , Felix C Tanner  1
Affiliations

Right vs. left ventricular longitudinal strain for mortality prediction after transcatheter aortic valve implantation

Neria E Winkler et al. Front Cardiovasc Med. .

Abstract

Introduction: This study aims at exploring biventricular remodelling and its implications for outcome in a representative patient cohort with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).

Methods and results: Pre-interventional echocardiographic examinations of 100 patients with severe AS undergoing TAVI were assessed by speckle tracking echocardiography of both ventricles. Association with mortality was determined for right ventricular global longitudinal strain (RVGLS), RV free wall strain (RVFWS) and left ventricular global longitudinal strain (LVGLS). During a median follow-up of 1,367 [959-2,123] days, 33 patients (33%) died. RVGLS was lower in non-survivors [-13.9% (-16.4 to -12.9)] than survivors [-17.1% (-20.2 to -15.2); P = 0.001]. In contrast, LVGLS as well as the conventional parameters LV ejection fraction (LVEF) and RV fractional area change (RVFAC) did not differ (P = ns). Kaplan-Meier analyses indicated a reduced survival probability when RVGLS was below the -14.6% cutpoint (P < 0.001). Lower RVGLS was associated with higher mortality [HR 1.13 (95% CI 1.04-1.23); P = 0.003] independent of LVGLS, LVEF, RVFAC, and EuroSCORE II. Addition of RVGLS clearly improved the fitness of bivariable and multivariable models including LVGLS, LVEF, RVFAC, and EuroSCORE II with potential incremental value for mortality prediction. In contrast, LVGLS, LVEF, and RVFAC were not associated with mortality.

Discussion: In patients with severe AS undergoing TAVI, RVGLS but not LVGLS was reduced in non-survivors compared to survivors, differentiated non-survivors from survivors, was independently associated with mortality, and exhibited potential incremental value for outcome prediction. RVGLS appears to be more suitable than LVGLS for risk stratification in AS and timely valve replacement.

Keywords: aortic stenosis; global longitudinal strain; mortality; speckle tracking echocardiography; transcatheter aortic valve implantation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Echocardiographic parameters dichotomised by survival status. RVFAC, right ventricular fractional area change (panel A); RVGLS, right ventricular global longitudinal strain (panel B); RVFWS, right ventricular free wall strain (panel C); LVEF, left ventricular ejection fraction (panel D); LVGLS, left ventricular global longitudinal strain (panel E). Mann–Whitney–Wilcoxon test was used for comparison of continuous variables within groups. *Significant values (P < 0.05).
Figure 2
Figure 2
Kaplan–Meier survival curves differentiating survivors from non-survivors with the cutpoints for right ventricular global longitudinal strain (RVGLS; panel A) and right ventricular free wall strain (RVFWS; panel B).
Figure 3
Figure 3
Incremental prognostic value of right ventricular global longitudinal strain (RVGLS) over baseline risk factors represented by EuroSCORE II (ESII; panel A) or left ventricular ejection fraction (LVEF; panel B); ns, non significant.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ancona R PCS. Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): is the prevalence of AS/AI similar in different parts of the world? (2020); Volume 18. Available at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volum...
    1. Alec Vahanian FB, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, et al. ESC/EACTS scientific document group. 2021 ESC/EACTS guidelines for the management of valvular heart disease: developed by the task force for the management of valvular heart disease of the European society of cardiology (ESC) and the European association for cardio-thoracic surgery (EACTS). Eur Heart J. (2022) 43(7):561–632. 10.1093/eurheartj/ehab395 - DOI - PubMed
    1. Généreux P, Pibarot P, Redfors B, Mack MJ, Makkar RR, Jaber WA, et al. Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J. (2017) 38(45):3351–8. 10.1093/eurheartj/ehx381 - DOI - PMC - PubMed
    1. Calcutteea A, Holmgren A, Lindqvist P, Henein MY. Organised right ventricular remodelling in aortic stenosis even after valve replacement. Int J Cardiol. (2013) 168(2):1549–50. 10.1016/j.ijcard.2012.12.029 - DOI - PubMed
    1. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling—concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol. (2000) 35(3):569–82. 10.1016/S0735-1097(99)00630-0 - DOI - PubMed