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. 2024 Jan 19;11(1):30.
doi: 10.3390/jcdd11010030.

Prognostic Value of Cardiac Magnetic Resonance Feature Tracking Strain in Aortic Stenosis

Vasiliki Tsampasian  1   2 , Ioannis Merinopoulos  1 , Thuwarahan Ravindrarajah  1 , Liam Ring  3 , Ee Ling Heng  4 , Sanjay Prasad  5 , Vassilios S Vassiliou  2
Affiliations

Prognostic Value of Cardiac Magnetic Resonance Feature Tracking Strain in Aortic Stenosis

Vasiliki Tsampasian et al. J Cardiovasc Dev Dis. .

Abstract

Background: Recent data have suggested that global longitudinal strain (GLS) could be useful for risk stratification of patients with severe aortic stenosis (AS). In this study, we aimed to investigate the prognostic role of GLS in patients with AS and also its incremental value in relation to left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE).

Methods: We analysed all consecutive patients with AS and LGE-CMR in our institution. Survival data were obtained from office of national statistics, a national body where all deaths in England are registered by law. Death certificates were obtained from the general register office.

Results: Some 194 consecutive patients with aortic stenosis were investigated with CMR at baseline and followed up for 7.3 ± 4 years. On multivariate Cox regression analysis, only increasing age remained significant for both all-cause and cardiac mortality, while LGE (any pattern) retained significance for all-cause mortality and had a trend to significance for cardiac mortality. Kaplan-Meier survival analysis demonstrated that patients in the best and middle GLS tertiles had significantly better mortality compared to patients in the worst GLS tertiles. Importantly though, sequential Cox proportional-hazard analysis demonstrated that GLS did not have significant incremental prognostic value for all-cause mortality or cardiac mortality in addition to LVEF and LGE.

Conclusions: Our study has demonstrated that age and LGE but not GLS are significant poor prognostic indicators in patients with moderate and severe AS.

Keywords: aortic stenosis; cardiovascular magnetic resonance; ejection fraction; global longitudinal strain; late gadolinium enhancement.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Box and whisker plots showing the distribution of LVEF by pattern of LGE on CMR. Outlier data are included in the plot. CMR: cardiac magnetic resonance, LGE: late gadolinium enhancement, LVEF: left ventricle ejection fraction.
Figure 2
Figure 2
Box and whisker plot showing the distribution of GLS by pattern of LGE on CMR. CMR: cardiac magnetic resonance, GLS: global longitudinal strain, LGE: late gadolinium enhancement.
Figure 3
Figure 3
Kaplan–Meier survival plot showing that patients in top two GLS tertiles had significantly better survival compared to bottom tertile, while there was no significant difference between the top two GLS tertiles. GLS: global longitudinal strain.
Figure 4
Figure 4
Sequential Cox proportional-hazard models demonstrating the incremental discriminatory value of differing CMR markers for all-cause mortality. (A) EF -> Gadolinium -> GLS; (B) EF -> GLS -> Gadolinium.
Figure 5
Figure 5
Sequential Cox proportional-hazard models demonstrating the incremental discriminatory value of differing CMR markers for cardiac mortality. (A) EF -> Gadolinium -> GLS; (B) EF -> GLS -> Gadolinium.
See this image and copyright information in PMC

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