Key Points
• Source: Journal of the American Society of Echocardiography
• Conclusions: “In patients with moderate AS, reduced LV global longitudinal strain (GLS) is associated with an increased risk of all-cause mortality, even if LVEF is still preserved.”
• In the current study, researchers assessed LV GLS via speckle tracking echo in 760 patients. Patients were divided into the following 3 groups: 1) LV ejection fraction <50% (group 1); 2) LVEF ≥50% but LV GLS <16%; and 3) LVEF ≥50% and LV GLS ≥16%. Of note, the LV GLS value of 16% was derived from spline curve analysis, with the primary outcome being all-cause mortality.
• The median follow-up was 50 months, during which 34% of patients died.
• The investigators found that moderate AS is correlated with an increased risk of death, LV GLS is independently correlated with survival in moderate AS, and LV GLS continued to be correlated with outcomes in asymptomatic patients who have preserved LVEF.
• “Recent studies showed that patients with moderate AS have a worse prognosis than initially assumed,” stated the authors. “Risk stratification models incorporating LV GLS could therefore improve identification of patients with moderate AS who are at increased risk of adverse events and may benefit from more intensive follow-up. Even in patients with a preserved LVEF, assessment of LV GLS could identify a subgroup of patients that have an increased risk of adverse events and the current study showed that long-term outcomes in patients with moderate AS and preserved LVEF but reduced LV GLS were not different from those with a reduced LVEF.”
• Limitations of the current study include its retrospective and observational design. Furthermore, because patients with substandard echocardiographic image quality for LV GLS analysis were excluded, selection bias may have occurred. Importantly, the measure of LV GLS is vendor-dependent, with incomparable values across different echo machines.