Abstract 228: Left Ventricular Mass Index and Plasma BNP Are Superior to Traditional Markers of Disease Severity for the Prediction of Early Left Ventricular Dysfunction in Aortic Stenosis
Background: Impaired left ventricular ejection fraction (LVEF) is an adverse prognostic marker in severe aortic stenosis (AS) and left ventricular (LV) pressure overload may result in permanent myocardial damage. This study of subjects with AS and preserved LVEF had two aims:
To assess the capacity of global longitudinal strain (GLS) with speckle tracking echocardiography (STE) to detect early LV dysfunction and
To determine predictors of GLS in AS subjects.
Methods: Subjects with AS (n=83) and age-matched controls (n=10) underwent conventional echocardiography and STE, in addition to comorbidity analysis and plasma BNP. Early LV dysfunction was defined as reduced GLS with LVEF>50%.
Results: Eighty-one subjects were analysed. In the AS cohort, age was 73±11 (mean±SD) years, male gender (56%), LVEF 64±8% and AS severity: mild (n=18), moderate (n=15) and severe (n=38). GLS was significantly reduced across the spectrum of AS severity (Fig 1⇓). Significant univariate associations with GLS were demonstrated for AS severity (r=0.56, p<0.001), LV mass index (LVMI) (r=0.50, p<0.001), logBNP (r=0.50, p<0.001), NYHA class (r=0.41, p=0.001), LVEF (r=−0.36, p<0.001) and history of hypertension (p=0.02) but not diabetes, ischemic heart disease or age. With linear regression, independent predictors of GLS were LVMI (p=0.001), LVEF (p<0.001) and BNP (p=0.01) but not AS severity or symptomatic class.
Conclusions: STE detects early LV dysfunction in subjects with AS. LVMI and plasma BNP are superior to AS severity and symptom class for prediction of early LV dysfunction. The prognostic significance of this finding requires further investigation.