Abstract
Backgrounds
Subclinical myocardial dysfunction detected by global longitudinal strain (GLS) using
echocardiography is associated with poor outcomes in patients with severe aortic stenosis
(AS) despite normal left ventricular ejection fraction (LVEF). Computed tomography
angiography derived GLS (CTA-GLS) has recently shown to be feasible, however the prognostic
value remains unclear in severe AS patients treated with transcatheter aortic valve
replacement (TAVR).
Methods
We analyzed consecutive patients who underwent TAVR with pre-TAVR retrospective gated
acquisition CTA study with adequate image quality covering the entire left ventricle.
CTA-GLS analysis was performed using 2D CT-Cardiac Performance Analysis prototype
software (TomTec GmbH). Kaplan-Meier and Cox regression analyses were performed to
evaluate the association of baseline CTA-GLS with all-cause mortality and a composite
outcome of all-cause death and hospitalization for heart failure after TAVR.
Results
A total of 223 patients were included (mean age 83.5 ± 6.8 years, 45.7% female, mean
CTA-LVEF 50.7 ± 14.5%). During a median follow-up of 32 months, 81 all-cause deaths
and 134 composite outcomes occurred. When compared to patients with normal LVEF (≥50%)
and preserved CTA-GLS (≤-20.5%), patients with normal LVEF but reduced CTA-GLS (>-20.5%)
had higher all-cause mortality (Chi-square 6.89, p = 0.032) and the risk of composite
outcome (Chi-square 7.80, p = 0.020) which was no different than those with impaired
LVEF. Reduced CTA-GLS was independently associated with all-cause mortality (HR 1.71,
95% CI 1.01–2.90, p = 0.049) and the risk of composite outcome (HR 1.51, 95% CI 1.01–2.25,
p = 0.044) on multivariable Cox regression analysis.
Conclusions
Reduced CTA-GLS provides independent prognostic value above multiple clinical and
echocardiographic characteristics.
Keywords
Abbreviations:
AS (aortic stenosis), CTA (computed tomography angiography), FT (feature tracking), GLS (global longitudinal strain), LV (left ventricular), LVEF (left ventricular ejection fraction), STS-PROM (the Society of Thoracic Surgeons Predicted Risk of Mortality), TAVR (transcatheter aortic valve replacement)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 05, 2019
Accepted:
December 5,
2019
Received in revised form:
November 5,
2019
Received:
July 26,
2019
Identification
Copyright
© 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
