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Prognostic Value of Left Ventricular Deformation Parameters in Patients with Severe Aortic Stenosis: A Pilot Study of the Usefulness of Strain Echocardiography.
- Source :
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Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography [J Am Soc Echocardiogr] 2017 Aug; Vol. 30 (8), pp. 727-735.e1. Date of Electronic Publication: 2017 Jun 07. - Publication Year :
- 2017
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Abstract
- Background: In patients with aortic stenosis, subtle alterations in myocardial mechanics can be detected by speckle-tracking echocardiography before reduction of left ventricular ejection fraction (LVEF).<br />Methods: In this prospective study, 162 patients with aortic stenosis with an average aortic valve area of 0.7 ± 0.2 cm <superscript>2</superscript> and a mean LVEF of 60 ± 11% were included. Global longitudinal strain (GLS) and mechanical dispersion (SD of time from Q/R on the electrocardiogram to peak strain in 16 left ventricular segments) were assessed using echocardiography, and all-cause mortality (n = 37) was recorded during 37 ± 13 months of follow-up.<br />Results: Overall, nonsurvivors had more pronounced mechanical dispersion and worse GLS compared with survivors (74 ± 24 vs 61 ± 18 msec [P < .01] and -14.5 ± 4.4% vs -16.7 ± 3.6% [P < .01], respectively). In the 42 conservatively treated patients without surgical aortic valve replacement, a similar pattern was observed in nonsurvivors versus survivors (mechanical dispersion, 80 ± 24 vs 57 ± 14 msec [P < .01]; GLS, -14.0 ± 4.9% vs -17.1 ± 3.8% [P = .04], respectively). Mechanical dispersion was significantly associated with mortality (hazard ratio per 10-msec increase, 1.23; 95% CI, 1.07-1.42; P < .01) in a Cox model adjusted for LVEF and with aortic valve replacement treatment as a time-dependent covariate. Continuous net reclassification improvement showed that mechanical dispersion was incremental to LVEF, GLS, and valvulo-arterial impedance when adjusting for aortic valve replacement treatment in the total population.<br />Conclusion: Increased mechanical dispersion may be a risk marker providing novel prognostic information in patients with aortic stenosis.<br /> (Copyright © 2017 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aortic Valve diagnostic imaging
Aortic Valve Stenosis epidemiology
Aortic Valve Stenosis physiopathology
Cause of Death
Echocardiography, Stress methods
Feasibility Studies
Female
Heart Ventricles physiopathology
Humans
Male
Morbidity trends
Norway epidemiology
Pilot Projects
Prospective Studies
ROC Curve
Risk Factors
Severity of Illness Index
Survival Rate trends
Aortic Valve Stenosis diagnosis
Echocardiography, Stress statistics & numerical data
Heart Ventricles diagnostic imaging
Risk Assessment
Stroke Volume physiology
Ventricular Function, Left physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6795
- Volume :
- 30
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
- Publication Type :
- Academic Journal
- Accession number :
- 28599826
- Full Text :
- https://doi.org/10.1016/j.echo.2017.04.009