Download Conservatively treated AS

V-9
Prognostic value of left ventricular deformation
parameters in patients with aortic stenosis
Lars Gunnar Klæboe, Trine F. Håland, Ida S. Leren, Rachel M.A. ter Bekke,
Helge Røsjø, Torbjørn Omland, Lars Gullestad, Svend Aakhus, Kristina H. Haugaa,
Thor Edvardsen
Dept of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo
Dept of Cardiology, Maastricht University Medical Centre, The Netherlands
Center for Heart Failure Research, University of Oslo
Dept of Cardiology, Division of Medicine, Akershus University Hospital
E-mail: [email protected]
Disclosures: None
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Introduction
• In aortic stenosis (AS) subtle alterations in myocardial mechanics can be detected by
speckle tracking echocardiography prior to reduction of left ventricular (LV) ejection
fraction (EF)
Purpose
• We aimed to investigate if parameters from strain echocardiography are markers of
prognosis in AS-patients
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METHODS
162 patients referred for evaluation of severe AS
We recorded all-cause mortality and number AVR performed during follow up
Baseline standard 2D echocardiography including speckle tracking strain
Global longitudinal strain (GLS): average of peak longitudinal shortening from a 16 LV
segments model
Mechanical dispersion: standard deviation of contraction duration defined as time from
onset of Q/R on ECG to peak longitudinal strain in 16 segments (Figure 1)
Survivor with low
mechanical dispersion (39 ms)
Contraction duration
Onset of QRS on
ECG
Non-survivor with pronounced
mechanical dispersion (76 ms)
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Overall results
• Follow-up 37 ± 13 months
16
• Surgical AVR (n = 120, 74%)
26
• Conservatively treated patients (n = 42) due to
comorbidity (n=19) or sparse symptoms (n=23)
were similarly distributed between survivors
and non-survivors (p=0.20)
• 37 (23%) patients died
• Overall survival closely related to AVR-status
(Kaplan, log rank < 0.01)
• Prognostic value of parameters from strain
echocardiography examined only in the
subgroup of conservatively treated patients
No. at risk
AVR
Conservatively treated patients
120
114
104
5
42
25
16
1
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Results - Conservatively treated AS-patients (n = 42)
Age, years
Men/women, n
NYHA class
AVA, cm2
GLS, %
IVSd, cm
LV ejection fraction, %
Mean AV gradient, mmHg
Mech. dispersion, ms
Survivors
(n=16)
Non-survivors
(n = 26)
80±7
5/11
2.1 ± 0.9
0.85±0.26
- 17.2±3.7
1.1 ± 0.2
60 ± 11
34 ± 17
60 ± 15
79±6
17/9
2.7 ± 1.0
0.70 ± 0.29
- 13.9±4.9
1.3 ± 0.2
53 ± 15
50 ± 21
80 ± 24
log rank
0.02
P-value
0.61
0.06
0.09
0.11
0.04
< 0.01
0.10
0.02
< 0.01
log rank
0.02
Mechanical dispersion predicted
mortality independently of LVEF and
age [HR =1.25 (1.05, 1.49), p=0.01,
per 10 ms increase].
Mech. dispersion > 65 ms
Mech. dispersion < 65 ms
GLS < -15.4 %
GLS > -15.4 %
Days (n)
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CONCLUSIONS
• Increased mechanical dispersion and reduced GLS in aortic stenosis
• is associated with increased mortality in conservatively treated patients
• may be additional risk factors
• can strengthen the indication for interventional treatment in patients
with preserved LVEF not eligible for AVR when using traditional criteria