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Baseline global longitudinal strain by computed tomography is associated with post transcatheter aortic valve replacement outcomes

Published:December 05, 2019DOI:https://doi.org/10.1016/j.jcct.2019.12.002

      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)
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