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Characterization of myocardial mechanics and its prognostic significance in patients with severe aortic stenosis undergoing aortic valve replacement

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单位: [1]Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, Rochester, MN 55905, USA. [2]Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan City, Hubei Province 430030, PR China. [3]Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada. [4]Department of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, Rochester, MN 55905, USA.
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Aortic stenosis (AS) induces characteristic changes in left ventricular (LV) mechanics that can be reversed after aortic valve replacement (AVR). We aimed to comprehensively characterize LV mechanics before and after AVR in patients with severe AS and identify predictors of short-term functional recovery and long-term survival.We prospectively performed comprehensive strain analysis by 2D speckle-tracking echocardiography in 88 patients with severe AS and LV ejection fraction ≥50% (mean age 71 ± 12 years, 42% female) prior to and within 7 days after AVR. Patients were followed for up to 5.2 years until death from any cause or last encounter. Within days after AVR, we observed an absolute increase in global longitudinal strain (GLS) (-16.0 ± 2.0% vs. -18.5 ± 2.1%, P<0.0001) and a decrease in apical rotation (10.5 ± 4.0° vs. 8.3 ± 2.8°, P = 0.0002) and peak systolic twist (18.2 ± 5.0° vs. 15.5 ± 3.8°, P = 0.0008). A baseline GLS is less negative than -16.2% was 90% sensitive and 67% specific in predicting a ≥ 20% relative increase in GLS. During a median follow-up of 3.8 years, a global circumferential systolic strain rate (GCSRs) less negative than -1.9% independently predicted lower survival.In patients with severe AS, a reversal in GLS, apical rotation, and peak systolic twist abnormalities towards normal occurs within days of AVR. Baseline GLS is the strongest predictor of GLS recovery but neither was associated with long-term survival. In contrast, abnormal baseline GCSRs are associated with worse outcomes.© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

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第一作者单位: [1]Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, Rochester, MN 55905, USA. [2]Department of Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan City, Hubei Province 430030, PR China.
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